Individual
JOSEPH BRADY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1030 SCOTT DR, PRESCOTT, AZ 86301-4737
(928) 778-2450
Mailing address
554 CAMPBELL ST, PRESCOTT, AZ 86301-2521
(928) 830-8572
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-012200
AZ
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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