Individual
DR. CLARK TANNER BILBREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
3691 WILLOWCREEK RD, PORTAGE, IN 46368-5080
(219) 921-1444
Mailing address
317 W 300 S, VALPARAISO, IN 46385-9629
(615) 290-2737
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013728A
IN
2255A2300X
Athletic Trainer
36003318A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05013728A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
01
—
36003318A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
06/02/2020
Last updated
06/02/2020
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