Individual
MARIAH LEYNA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2000 MEDICAL DR, LAKEWAY, TX 78734-4200
(717) 975-4790
Mailing address
14 SNELL DR, LAMPASAS, TX 76550-3621
(254) 258-3863
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT8212
TX
Other
Enumeration date
06/23/2021
Last updated
06/23/2021
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