Individual
MR. GREGORY RAY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3 WINDSOR CT, SHAWNEE, OK 74804-2330
(405) 623-9695
Mailing address
3 WINDSOR COURT, SHAWNEE, OK 74804
(405) 623-9695
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2604
OK
Other
Enumeration date
03/14/2007
Last updated
10/10/2012
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