Individual
DR. JOHN HARRISON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
7600 N MINERAL DR STE 500, COEUR D ALENE, ID 83815-9425
(208) 457-4208
(208) 457-4197
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-2300
(208) 262-2390
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316682297
—
ID
Enumeration date
05/04/2022
Last updated
08/11/2022
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