Individual
CLARK O VANDEGRAFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3614 N ROCHELLE LN, PEORIA, IL 61604-1039
(309) 688-0350
Mailing address
109 BERRY ROAD, MARQUETTE HEIGHTS, IL 61554
(309) 840-1720
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
02/13/2019
Last updated
02/13/2019
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