Individual
KELLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
970 HILLTOP DR, WEATHERFORD, TX 76086-5488
(817) 808-1633
Mailing address
3025 YUCCA RD, WILLOW PARK, TX 76087-7116
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2109081
TX
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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