Individual
JOSEPH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1007 GROVE RD, GREENVILLE, SC 29605-4630
(864) 370-9211
Mailing address
702 EDWARDS RD APT 79, GREENVILLE, SC 29615-1264
(864) 915-9032
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1880
LICENSE #
SC
Enumeration date
08/30/2006
Last updated
07/08/2007
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