Individual
DR. CLARK TANNER BILBREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
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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