Individual
MS. LUCY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LUCY CLARK
Contact information
Practice address
432 2ND ST S, JACKSONVILLE BEACH, FL 32250-6764
(352) 235-2125
(352) 473-9572
Mailing address
7011 GATORBONE RD, KEYSTONE HEIGHTS, FL 32656-8195
(352) 235-2125
(352) 473-9572
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA0013899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C7459
BCBS PROVIDER
FL
Enumeration date
04/12/2007
Last updated
07/08/2007
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