Individual
AMANDA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 HERR LN, LOUISVILLE, KY 40222-4388
(502) 412-9383
Mailing address
1301 HERR LN, LOUISVILLE, KY 40222-4388
(502) 412-9383
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5029
KY
Other
Enumeration date
03/06/2014
Last updated
03/06/2014
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