Individual
AMANDA MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
200 PATEWOOD DR, STE C150, GREENVILLE, SC 29615-3593
(864) 545-0904
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7101
SC
Other
Enumeration date
08/07/2013
Last updated
01/15/2019
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