Individual
CHANDLER CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3100 OLYMPUS BLVD STE 500, COPPELL, TX 75019-5473
(214) 442-4329
Mailing address
5401 HOLLYTREE DR APT 3002, TYLER, TX 75703-3486
(903) 520-0593
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2182964
TX
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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