Provider Demographics
NPI:1891429122
Name:CLARK, SAVANNAH MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:MARIE
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1003 SOUTH MISSOURI STREET
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1385
Mailing Address - Country:US
Mailing Address - Phone:660-385-6244
Mailing Address - Fax:660-385-4821
Practice Address - Street 1:1003 SOUTH MISSOURI STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1385
Practice Address - Country:US
Practice Address - Phone:660-385-6244
Practice Address - Fax:660-385-4821
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist