Individual
JACOB LARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4766 BELPAR ST NW, CANTON, OH 44718
(330) 244-1001
Mailing address
13171 MARINER DR, NORTH ROYALTON, OH 44133-5980
(440) 879-6266
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
018124
OH
225100000X
Physical Therapist
PT018124
OH
261QP2000X
Physical Therapy Clinic/Center
297919
CA
Other
Enumeration date
01/06/2020
Last updated
10/09/2020
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