Individual
MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
84 OXFORD ROAD, OXFORD, CT 06478-1971
(203) 881-0830
(203) 881-0894
Mailing address
22 TOMPKINS STREET, WATERBURY, CT 06708-1458
(203) 419-0381
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13032
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190328
—
CT
Enumeration date
04/01/2021
Last updated
04/01/2021
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