Individual
GINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
551 LONE PINE BLVD, THE DALLES, OR 97058-9403
(541) 296-7202
Mailing address
5455 HIGHWAY 35, MOUNT HOOD PARKDALE, OR 97041-7744
(503) 504-1445
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60194
OR
Other
Enumeration date
01/08/2014
Last updated
04/18/2016
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