Individual
BRENDON MATTHEW CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05015804A
IN
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Enumeration date
02/12/2019
Last updated
12/03/2024
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