Individual
MR. CLARK SEBASTIAN SHIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AT, ATC
Contact information
Practice address
7311 E SOUTHERN AVE APT 2034, MESA, AZ 85209-2712
(413) 348-3145
Mailing address
7311 E SOUTHERN AVE APT 2034, MESA, AZ 85209-2712
(413) 348-3145
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1142
AZ
Other
Enumeration date
04/29/2014
Last updated
04/29/2014
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