Individual
LATISHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
4301 BROADWAY ST, SAN ANTONIO, TX 78209-6318
(210) 829-3826
Mailing address
4301 BROADWAY ST, SAN ANTONIO, TX 78209-6318
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT4794
TX
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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