Individual
AMY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
506 NE STATE ROUTE 291, LEES SUMMIT, MO 64086-2533
(816) 246-4054
Mailing address
1205 BIRCH DR, GREENWOOD, MO 64034-9214
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02285
LICENSE #
MO
Enumeration date
08/23/2006
Last updated
07/08/2007
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