Provider Demographics
NPI:1932326196
Name:BETTUCHY CLARK, SARAH J (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:J
Last Name:BETTUCHY CLARK
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1934
Mailing Address - Country:US
Mailing Address - Phone:714-356-7174
Mailing Address - Fax:
Practice Address - Street 1:13010 HEATH GROVE DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4236
Practice Address - Country:US
Practice Address - Phone:714-356-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer