Individual
MR. JASON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1001 GIESAU DR, ONTONAGON, MI 49953-1454
(906) 884-6092
Mailing address
805 ELM STREET, ROCKLAND, MI 49960-0261
(906) 886-2660
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
L2065720
MI
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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