Individual
JASON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10908 STONEY CREEK CT, INDIANAPOLIS, IN 46239-9481
(765) 969-9816
Mailing address
10908 STONEY CREEK CT, INDIANAPOLIS, IN 46239-9481
(765) 969-9816
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003774A
IN
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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