Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1833 | NC |
NPI | 1700238227 |
---|---|
Provider Name | Ms. Britani Clark |
First Address | Lake City, FL 32025-5808 |
Second Address | Lake City, FL 32025-5808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |