Individual
MRS. MARIE D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1337 W GRAND ST, GALLATIN, MO 64640-8320
(660) 663-2197
(660) 663-4128
Mailing address
1337 W GRAND ST, GALLATIN, MO 64640-8320
(660) 663-2197
(660) 663-4128
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2001001897
MO
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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