Individual
STACY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11623 ARBOR ST, OMAHA, NE 68144-2981
(800) 334-1919
(402) 334-6844
Mailing address
635 ALPINE DR, GROVE, OK 74344-2602
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2910
OK
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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