Individual
DR. EBONY JACKSON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LPT-31648
AZ
225100000X
Physical Therapist
PT027785
PA
Other
Enumeration date
08/05/2019
Last updated
02/18/2025
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