Individual
MR. TIMOTHY ROSS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
201 10TH AVE N, TWIN FALLS, ID 83301-6372
(208) 734-4264
Mailing address
201 10TH AVE N, TWIN FALLS, ID 83301-6372
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA168
ID
Other
Enumeration date
11/27/2012
Last updated
11/27/2012
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