Individual
JAMES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7169 KALAMAZOO AVE SE STE 200, CALEDONIA, MI 49316-8146
(616) 827-3010
Mailing address
4761 LAKE MICHIGAN DR NW STE A, GRAND RAPIDS, MI 49534-6300
(616) 608-9978
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501018851
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501018851
LICENSE
MI
Enumeration date
08/24/2018
Last updated
10/14/2019
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