Individual
STEPHEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 MAIN ST NW STE 1&2, LOS LUNAS, NM 87031-4812
(505) 865-4368
Mailing address
2401 CABEZON BLVD SE STE 102, RIO RANCHO, NM 87124-1513
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1502
NM
Other
Enumeration date
01/03/2023
Last updated
01/03/2023
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