Provider Demographics
NPI:1164480398
Name:CLARKE, LAURA (PT, ATC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GRAYBASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2100
Mailing Address - Country:US
Mailing Address - Phone:215-284-3387
Mailing Address - Fax:
Practice Address - Street 1:4 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:215-284-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027102225100000X
PART001901A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer