Individual
KAITLIN T CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
15410 S MOUNTAIN PKWY, STE: 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7409
Mailing address
15410 S MOUNTAIN PKWY, STE: 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7409
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9504
AZ
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
10/13/2011
Last updated
11/23/2011
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