Individual
KIERAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20601 E DIXIE HWY STE 300, AVENTURA, FL 33180-1542
(305) 933-5942
Mailing address
1320 NE 103RD ST, MIAMI SHORES, FL 33138-2624
(305) 945-1241
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA14682
LICENSE #
FL
Enumeration date
08/30/2006
Last updated
07/08/2007
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