Individual
MARY ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1200 OAKLEAF WAY, STE B, ALTOONA, WI 54720-2245
(715) 839-9266
(715) 839-8761
Mailing address
1200 OAKLEAF WAY, STE B, ALTOONA, WI 54720-2245
(715) 839-9266
(715) 839-8761
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3727024
WI
2251X0800X
Orthopedic Physical Therapist
Primary
3727024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40210700
—
WI
Enumeration date
04/27/2006
Last updated
12/01/2021
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