Individual
MR. CASEY J. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2170 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 234-8559
(662) 234-7923
Mailing address
2170 S LAMAR BLVD, OXFORD, MS 38655-5224
(662) 234-8559
(662) 234-7923
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3203
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01802208
—
MS
Enumeration date
06/17/2005
Last updated
07/08/2007
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