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Individual
MICHAEL J CLARK
Active
Individual
MICHAEL J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2569
OR
225100000X
Physical Therapist
Primary
PT00005772
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0766690001
CIGNA GOVERNMENT SERVICES
WA
01
—
108672
LABOR & INDUSTRIES PROVID
WA
01
—
650011919
RAILROAD MEDICARE
WA
05
—
8348476
—
WA
01
—
CL5823
REGENCE BC/BS
WA
Enumeration date
05/27/2005
Last updated
09/15/2022
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