Individual
EDWARD CLARK SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3016 W MAIN ST, RUSSELLVILLE, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658
Mailing address
3016 W MAIN ST, RUSSELLVILLE, RUSSELLVILLE, AR 72801-2453
(479) 967-9657
(479) 967-9658
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2693
AR
Other
Enumeration date
12/20/2011
Last updated
05/16/2012
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