Individual
CALEB CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
178 MIDDLE STREET, 504, PORTLAND, ME 04101
(207) 699-8483
Mailing address
163 NEAL ST APT 2L, PORTLAND, ME 04102-3358
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MT4787
ME
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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