Individual
ALLIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
404 HUNTER ST, ESPANOLA, NM 87532-2655
(505) 753-4123
Mailing address
2491 SAWMILL RD APT 1105, SANTA FE, NM 87505-5677
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5724
NM
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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