Individual
JENNIFER EVANGELINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
878 HIGHWAY 411 N, ETOWAH, TN 37331-1912
(423) 263-7070
(423) 263-7077
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4826
TN
Other
Enumeration date
10/30/2010
Last updated
10/30/2010
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