Individual
MS. TIFFANY DEVON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
432 HERMITAGE DR., DANVILLE, VA 24541
(434) 793-1548
Mailing address
10072 MOUNT CROSS RD., DANVILLE, VA 24541
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306601562
VA
Other
Enumeration date
06/28/2007
Last updated
07/08/2007
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