Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT30667 | FL |
N | 225700000X | Massage Therapist | MA40447 | FL |
NPI | 1003121088 |
---|---|
Provider Name | Ms. Jennifer Lynnette Clarkson |
First Address | Sarasota, FL 34232-2138 |
Second Address | Sarasota, FL 34233-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 08/09/2015 |