Individual
BROOKE MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
640 WORTH STREET, CORRY, PA 16407-8515
(814) 664-9606
(814) 665-0036
Mailing address
1100 SHAWNEE ROAD, LIMA, OH 45805
(419) 999-2030
(419) 991-0909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
TEI000420
PA
225200000X
Physical Therapy Assistant
TEI000420
PA
Other
Enumeration date
05/12/2010
Last updated
12/02/2015
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