Individual
MACKENZIE MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(812) 598-7583
Mailing address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(812) 598-7583
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001685A
IN
Other
Enumeration date
09/22/2014
Last updated
03/08/2016
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