Individual
DIANE MAXINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
13560 WAYZATA BLVD, MINNETONKA, MN 55305-1850
(952) 525-1883
Mailing address
5760 ROSEWOOD LN N, PLYMOUTH, MN 55442-1411
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1425
MN
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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