| Doctor Name: | ANGELLA CLARK |
| NPI Number: | 1700278447 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMT |
| License Number: | 227005736 |
| Business Practice Address: | 23819 W Mill St Suite 7 Plainfield, IL - 605443457 |
| Business Phone Number: | 8154080071 |
| Business Fax Number: | |
| Mailing Address: | 1400 N Rock Run Dr, Apt. D2 CREST HILL |
| State: | IL |
| Postal Code: | 604038322 |
| Phone Number: | 7083412026 |
| Fax Number: | |
| NPI Enumeration Date: | 03/03/2015 |
| NPI Last Update Date: | 03/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 227005736 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |