Individual
KEITH ANTHONY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11311 N CENTRAL EXPY, STE 211, DALLAS, TX 75243-6707
(214) 315-2959
Mailing address
PO BOX 273326, FORT COLLINS, CO 80527-3326
(866) 996-2772
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT111749
TX
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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