Individual
MR. CHAD ALAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
58 GLENROYAL DR, PUEBLO, CO 81005-2174
(719) 565-6678
(719) 561-0577
Mailing address
58 GLENROYAL DR, PUEBLO, CO 81005-2174
(719) 565-6678
(719) 561-0577
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5835
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36630233
—
CO
Enumeration date
05/24/2005
Last updated
09/01/2011
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