Individual
JON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2932 SUNNYSTONE WAY, RALEIGH, NC 27613-6192
(919) 906-8310
Mailing address
2932 SUNNYSTONE WAY, RALEIGH, NC 27613-6192
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345678
STATE LICENSE
—
Enumeration date
03/16/2016
Last updated
03/16/2016
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