| Doctor Name: | BETHANY CLARK |
| NPI Number: | 1417296260 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT, DPT |
| License Number: | PT28112 |
| Business Practice Address: | 6500 Crill Ave Suite 3 Palatka, FL - 321779230 |
| Business Phone Number: | 3864459444 |
| Business Fax Number: | |
| Mailing Address: | 108 Camden Cay Dr, ST AUGUSTINE |
| State: | FL |
| Postal Code: | 320861814 |
| Phone Number: | 4408645565 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2013 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT28112 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |