Organization
ATHLETIC PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN CLARK DPT (PRESIDENT)
(818) 340-2002
Entity
Organization
Contact information
Practice address
12424 WILSHIRE BLVD, SUITE 101, LOS ANGELES, CA 90025-1052
(310) 826-2977
Mailing address
30877 THOUSAND OAKS BLVD, WESTLAKE VILLAGE, CA 91362-4039
(818) 879-2091
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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