Individual
JULIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
14929 SANDSTONE PL, GRAND HAVEN, MI 49417-7947
(231) 327-9578
Mailing address
14929 SANDSTONE PL, GRAND HAVEN, MI 49417-7947
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501009461
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306876438
—
MI
Enumeration date
03/02/2018
Last updated
03/17/2018
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