Provider Demographics
NPI:1083705263
Name:DAVIS-CLARK, TERRY E (PT)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:E
Last Name:DAVIS-CLARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3096
Mailing Address - Country:US
Mailing Address - Phone:315-464-6312
Mailing Address - Fax:315-464-6480
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:STE. 100
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3096
Practice Address - Country:US
Practice Address - Phone:315-464-6312
Practice Address - Fax:315-464-6480
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008697-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist