Individual
DR. KELLY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, PT, MT
Contact information
Practice address
2620 N WALNUT ST, SUITE 600, BLOOMINGTON, IN 47404-2008
(812) 558-0708
Mailing address
2620 N WALNUT ST, SUITE 600, BLOOMINGTON, IN 47404-2008
(812) 558-0708
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013530A
IN
225700000X
Massage Therapist
MT21304740
IN
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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