Provider Demographics
NPI:1346609872
Name:CLARK, NAOMI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3243 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3553
Mailing Address - Country:US
Mailing Address - Phone:828-393-5168
Mailing Address - Fax:865-951-7273
Practice Address - Street 1:4381 BELLS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1309
Practice Address - Country:US
Practice Address - Phone:828-393-5168
Practice Address - Fax:865-951-7273
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist