Provider Demographics
NPI:1831228501
Name:CLARK, JUDE JOSEPH II (PT)
Entity type:Individual
Prefix:MR
First Name:JUDE
Middle Name:JOSEPH
Last Name:CLARK
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 RUE DE LA HBR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1143
Mailing Address - Country:US
Mailing Address - Phone:504-220-4380
Mailing Address - Fax:
Practice Address - Street 1:4416 RUE DE LA HBR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1143
Practice Address - Country:US
Practice Address - Phone:504-220-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist