Clark, Susan

Clark, Susan is an individual health care provider with primary practice located at 1250 S A W Grimes Blvd , Round Rock TX 78664-7429. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Clark, Susan can be contacted via phone (512) 310-7665.

Contact Information

Primary practice address
1250 S A W Grimes Blvd Round Rock TX 78664-7429
Phone: (512) 310-7665
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 2068753 Texas

Profile Details

NPI number 1144593336
LBN Legal business name Clark, Susan
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 17th, 2012
Last updated Feb 17th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144593336 NPPES
Texas Other 0031DG BLUE CROSS BLUE SHIELD
Texas MEDICAID 0944746-02 BLUE CROSS BLUE SHIELD

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