Organization
PRO PHYSICAL THERAPY LLC
Active
Organization
PRO PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALLAS LAYNE CLARK PT (OWNER/PHYSICAL THERAPIST)
(435) 946-3512
Entity
Organization
Contact information
Practice address
20 ADAVILLE DRIVE, SUITE 10, DIAMONDVILLE, WY 83116
(307) 877-1000
(307) 877-1000
Mailing address
PO BOX 152, LAKETOWN, UT 84038-0152
(435) 946-3512
(435) 946-2311
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
802
WY
Other
Enumeration date
09/25/2007
Last updated
09/25/2007
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