Individual
JEFFREY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1010 W MAIN ST, HENDERSON, TX 75652-2923
(903) 657-6945
(903) 657-9061
Mailing address
115 KELLI DR, FORNEY, TX 75126-9564
(972) 552-3419
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2004982
TX
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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