Basic Information
| Provider Information | |||||||||
| NPI: | 1811237373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7310 RITCHIE HWY | ||||||||
| Address2: | 500 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107664047 | ||||||||
| FaxNumber: | 4107664049 | ||||||||
| Practice Location | |||||||||
| Address1: | 1460 RITCHIE HWY | ||||||||
| Address2: | 113 | ||||||||
| City: | ARNOLD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210122730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106268350 | ||||||||
| FaxNumber: | 4106268351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2013 | ||||||||
| LastUpdateDate: | 02/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18492 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.