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Individual

KYLE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
3155 N POINT PKWY, ALPHARETTA, GA 30005-5481
(815) 382-9497
Mailing address
3155 N POINT PKWY, ALPHARETTA, GA 30005-5481

Taxonomy

Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
140547
CHILDREN'S HEALTHCARE OF ATLANTA
Enumeration date
03/26/2020
Last updated
03/26/2020
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