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Individual

PHILLIP CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628
(812) 870-9822
Mailing address
4560 SE INTERNATIONAL WAY STE 100, MILWAUKIE, OR 97222-4628

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
60915368
WA

Other

Enumeration date
06/04/2019
Last updated
06/04/2019
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