Individual
PROF. ROGER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, PHD
Contact information
Practice address
2200 BONFORTE BLVD, PUEBLO, CO 81001-4901
(719) 549-2530
(719) 549-2549
Mailing address
2200 BONFORTE BLVD, PUEBLO, CO 81001-4901
(719) 549-2530
(719) 549-2549
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
627
CO
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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