Provider Demographics
NPI:1306087119
Name:CLARK, ALLISON M (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1173 RUNNING BROOK RD.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107
Mailing Address - Country:US
Mailing Address - Phone:704-787-0515
Mailing Address - Fax:607-746-6373
Practice Address - Street 1:211 W. MATTHEWS ST.
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-846-0262
Practice Address - Fax:607-746-6373
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017564-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist