Individual
JOEL ELLIS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
107 RABBIT TRL, WILMORE, KY 40390-1481
(859) 321-2741
Mailing address
107 RABBIT TRL, WILMORE, KY 40390-1481
(859) 321-2741
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005026
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP-224
—
KY
Enumeration date
04/23/2008
Last updated
04/23/2008
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