Individual
DONALD LEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
9908 GULF DRIVE, ANNA MARIA, FL 34216
(941) 778-8641
(941) 779-2291
Mailing address
PO BOX 669, ANNA MARIA, FL 34216-0669
(941) 778-8641
(941) 779-2291
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT20159
STATE LICENSE
FL
Enumeration date
03/20/2007
Last updated
07/08/2007
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