Individual
MICHAEL ANTHONY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2510 NACOGDOCHES RD, SAN ANTONIO, TX 78217-6025
(210) 829-8830
Mailing address
PO BOX 201911, SAN ANTONIO, TX 78220-8911
(757) 968-0264
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT134239
TX
Other
Enumeration date
06/27/2021
Last updated
06/27/2021
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