Individual
TRACEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2201 MAIN ST, #1200, DALLAS, TX 75201-4327
(972) 900-2708
Mailing address
2201 MAIN ST, 1200, DALLAS, TX 75201-4327
(972) 900-2708
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
225700000X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225700000X
MASSAGE THERAPY
TX
Enumeration date
03/07/2016
Last updated
03/07/2016
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