Individual
KEITH WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
406 S MAIN ST, WINNSBORO, TX 75494-3226
(903) 342-6790
(903) 342-6796
Mailing address
303 PAMELA DR, MINEOLA, TX 75773-1327
(903) 363-5038
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
041.0134009
VT
225200000X
Physical Therapy Assistant
1445
NH
225200000X
Physical Therapy Assistant
Primary
2015517
TX
225200000X
Physical Therapy Assistant
CP022392A
MD
225200000X
Physical Therapy Assistant
CP026481A
VA
Other
Enumeration date
05/01/2018
Last updated
07/12/2024
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