Individual
BRIAN KEITH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1407 MELBOURNE ST, FOSTER CITY, CA 94404-3960
(650) 759-1872
Mailing address
1407 MELBOURNE ST, FOSTER CITY, CA 94404-3960
(650) 759-1872
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 2497
CA
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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