Individual
DUSTY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5333 N PORT WASHINGTON RD STE B, GLENDALE, WI 53217-4914
(414) 716-1770
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
(586) 350-2644
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1880-19
WI
Other
Enumeration date
01/26/2018
Last updated
07/21/2021
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