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Individual

ELAINE M CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
710 NW JUNIPER ST, ISSAQUAH, WA 98027-2717
(425) 392-7989
Mailing address
2415 E MCGRAW ST, SEATTLE, WA 98112-2633
(206) 726-9379

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT00000762
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7038649
WA
Enumeration date
10/15/2006
Last updated
07/08/2007
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