Individual
MR. CHAMP MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T, PT, CSCS
Contact information
Practice address
17350 ST LUKES WAY, SUITE 100, THE WOODLANDS, TX 77384-4100
(936) 321-0333
Mailing address
8 S CYPRESS PINE DR, SPRING, TX 77381-2811
(713) 819-9350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1208709
TX
Other
Enumeration date
09/08/2011
Last updated
09/08/2011
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