Lydia Mikula Clackum, DPT

NPI #1295228781 in Loganville, Georgia

Provider Information

NPI Number: 1295228781
Entity Type: Individual
Name: Lydia Mikula Clackum, DPT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: DPT
Enumeration Date: Jun 11, 2018
Last Updated: Jun 11, 2018

Practice Location

Address: 3455 HIGHWAY 81 SOUTH
City: Loganville
State: Georgia
ZIP Code: 30052-3918
Phone: (678) 635-8280

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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