Individual
CONIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 EAST ST, CLARENCE, MO 63437-1902
(660) 699-2118
Mailing address
12864 HARVESTOR AVE, NEW CAMBRIA, MO 63558-3135
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2020021602
MO
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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