Individual
MR. CHARLES KEVIN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
10214 N TATUM BLVD, SUITE B-500, PHOENIX, AZ 85028-4224
(480) 264-6326
(480) 264-6328
Mailing address
10214 N TATUM BLVD, STE B500, PHOENIX, AZ 85028-4224
(480) 236-5360
(480) 991-0139
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5471
AZ
Other
Enumeration date
08/02/2006
Last updated
09/09/2019
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