Provider Demographics
NPI:1184689358
Name:CLARKE-HORNE, NICANDRA (PT)
Entity Type:Individual
Prefix:MS
First Name:NICANDRA
Middle Name:
Last Name:CLARKE-HORNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICANDRA
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:800 POLY PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-630-3654
Mailing Address - Fax:718-630-2983
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-3654
Practice Address - Fax:718-630-2983
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist