Individual
MR. JAMES DAVID CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
414 W MAIN ST, LAKE CITY, SC 29560-2318
(843) 374-7378
(843) 374-7379
Mailing address
414 WEST MAIN STREET, LAKE CITY, SC 29560-2318
(843) 374-7378
(843) 374-7379
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1126
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1126
LICENSE NUMBER
SC
Enumeration date
05/24/2007
Last updated
07/08/2007
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