Provider Demographics
NPI:1780843730
Name:CLARK PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CLARK PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:304-636-4070
Mailing Address - Street 1:108 3RD ST STE 26
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3831
Mailing Address - Country:US
Mailing Address - Phone:304-636-4070
Mailing Address - Fax:304-636-4070
Practice Address - Street 1:108 3RD ST STE 26
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3831
Practice Address - Country:US
Practice Address - Phone:304-636-4070
Practice Address - Fax:304-636-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy