Individual
JOANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2730 MICHENER DR, FORT COLLINS, CO 80526-6237
(970) 402-0398
Mailing address
2730 MICHENER DR, FORT COLLINS, CO 80526-6237
(970) 402-0398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL0005550
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTL00005550
COLORADO DEPARTMENT OF REGULARTORY AGENCIES
CO
Enumeration date
04/14/2016
Last updated
04/14/2016
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