Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1033646815 |
---|---|
Provider Name | Emily Clarke |
First Address | Woodbine, MD 21797 |
Second Address | Cherry Hill, NJ 08003-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 14/03/2019 |