Individual
DR. JAY BRADFORD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DSCPT, MPT
Contact information
Practice address
4807 BENSON AVE., BALTIMORE, MD 21227-1530
(410) 242-8963
(410) 242-8965
Mailing address
4807 BENSON AVE., BALTIMORE, MD 21227-1530
(410) 242-8963
(410) 242-8965
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
18491
MD
2251G0304X
Geriatric Physical Therapist
18491
MD
2251P0200X
Pediatric Physical Therapist
18491
MD
2251X0800X
Orthopedic Physical Therapist
Primary
18491
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020880900
—
MD
Enumeration date
03/22/2007
Last updated
07/17/2009
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