Provider Demographics
NPI:1801938774
Name:CLARK, ELIZABETH ANN (ATC)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
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 1:1100 E WYOMISSING BLVD
Mailing Address - Street 2:APT 34-C
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-2142
Mailing Address - Country:US
Mailing Address - Phone:610-763-3337
Mailing Address - Fax:
Practice Address - Street 1:430 NEW SCHAEFFERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BERNVILLE
Practice Address - State:PA
Practice Address - Zip Code:19506-8939
Practice Address - Country:US
Practice Address - Phone:610-763-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer