Individual
JESSICA GRANGER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 COMMERCE ST, RUSTON, LA 71270-6659
(318) 224-8994
Mailing address
1110 HIGHWAY 556, CHOUDRANT, LA 71227-9790
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9612
SC
Other
Enumeration date
04/29/2019
Last updated
03/25/2025
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