Individual
MISS LORI ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
OLD MIDLAND TRAIL-RT. 60, ANSTED, WV 25812
(304) 658-5271
(304) 658-4113
Mailing address
HC 60 BOX 15A, RUSSELLVILLE ROAD, NALLEN, WV 26680-9501
(304) 438-6795
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000599
WV
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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