Provider Demographics
NPI:1811237373
Name:CLARK, GINGER LEE (PT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:LEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:500
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:410-766-4049
Practice Address - Street 1:1460 RITCHIE HWY
Practice Address - Street 2:113
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2730
Practice Address - Country:US
Practice Address - Phone:410-626-8350
Practice Address - Fax:410-626-8351
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD18492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist