Individual
MISS HEATHER LACEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
703 E MAIN ST UNIT 1, LEBANON, KY 40033-8696
(270) 699-9503
(270) 699-3804
Mailing address
703 E MAIN ST UNIT 1, LEBANON, KY 40033-8696
(270) 699-9503
(270) 699-3804
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006757
KY
Other
Enumeration date
09/22/2015
Last updated
05/08/2018
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