Individual
ELLEN E CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 354-4488
(601) 914-1835
Mailing address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 354-4488
(601) 914-1835
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5084
MS
Other
Enumeration date
06/06/2012
Last updated
03/25/2014
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