Provider Demographics
NPI:1972635993
Name:CLARK, SABRINA K (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:K
Last Name:CLARK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:TN
Mailing Address - Zip Code:38330-2214
Mailing Address - Country:US
Mailing Address - Phone:731-676-3739
Mailing Address - Fax:
Practice Address - Street 1:569 SKYLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-676-3739
Practice Address - Fax:731-286-4259
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000007662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer