Individual
MR. CLARK ALBERT HEADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
165 MECHANIC ST, WATERTOWN, NY 13601-2677
(315) 778-1317
Mailing address
615 HOLCOMB ST APT 13, WATERTOWN, NY 13601-3973
(315) 778-1317
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029616
NY
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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