Provider Demographics
NPI:1538449053
Name:CLARKSON, MARAH CHRISTINE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MARAH
Middle Name:CHRISTINE
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:MARAH
Other - Middle Name:CHRISTINE
Other - Last Name:PACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:314 DARCY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-3517
Mailing Address - Country:US
Mailing Address - Phone:304-952-1351
Mailing Address - Fax:
Practice Address - Street 1:314 DARCY DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-3517
Practice Address - Country:US
Practice Address - Phone:304-952-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603115225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant