Individual
THERON A CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13327 231ST ST, LAURELTON, NY 11413-2121
(646) 725-9403
Mailing address
13327 231ST ST, LAURELTON, NY 11413-2121
(646) 725-9403
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0274631
NY
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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