Individual
MRS. PENNY JO CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1600 23RD ST, BEDFORD, IN 47421-4704
(812) 276-1282
(812) 276-1281
Mailing address
2260 MOUNT PLEASANT RD, BEDFORD, IN 47421-8038
(812) 275-2243
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008530A
IN
Other
Enumeration date
06/28/2007
Last updated
07/08/2007
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