Provider Demographics
NPI:1972282192
Name:CLARKE, EVA ANN (CMT)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24170 VIEW POINTE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5111
Mailing Address - Country:US
Mailing Address - Phone:805-573-3586
Mailing Address - Fax:
Practice Address - Street 1:24509 WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2846
Practice Address - Country:US
Practice Address - Phone:661-299-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist