Pamela R. Clack
Physical Therapist - Pediatrics
703 Kings Rdg
Monroe
, Georgia 30655-2051
Pamela R. Clack
Physical Therapist - Pediatrics
703 Kings Rdg
Monroe
, Georgia 30655-2051
(706) 752-1596
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About
Features
Specialties
- Physical Therapist - Pediatrics
Languages spoken
- English
Location
First Address
- Pamela R. Clack
- 1500 Launius Rd
- Good Hope, GA
- Zip : 30641-2637
- Fax : (706) 752-1596
- Phone : (706) 752-0779
Second Address
- Pamela R. Clack
- 703 Kings Rdg
- Monroe, GA
- Zip : 30655-2051
- Fax : (770) 207-5708
- Phone : (770) 207-5788
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2251P0200X | Physical Therapist - Pediatrics | 001415 | GA |
National Provider Identifier
| NPI | 1053476929 |
|---|---|
| Provider Name | Pamela R. Clack |
| First Address | Good Hope, GA 30641-2637 |
| Second Address | Monroe, GA 30655-2051 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/12/2006 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.