Individual
KEVIN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1315 WALNUT ST, PHILADELPHIA, PA 19107-4719
(609) 707-6771
Mailing address
1929 SPRUCE ST APT 3R, PHILADELPHIA, PA 19103-5719
(609) 707-6771
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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