Provider Demographics
NPI:1285968172
Name:CLARKE, SIOBHAN (PT)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 LONG BEACH RD # 202
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1361
Mailing Address - Country:US
Mailing Address - Phone:516-992-2282
Mailing Address - Fax:516-415-7604
Practice Address - Street 1:2421 LONG BEACH RD # 202
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1361
Practice Address - Country:US
Practice Address - Phone:516-992-2282
Practice Address - Fax:516-415-7604
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026541225100000X
NY026541-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist