Individual
JUSTIN THOMAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
7300 S RAEFORD RD, FAYETTEVILLE, NC 28304-6162
(910) 908-2222
Mailing address
7300 S RAEFORD RD, FAYETTEVILLE, NC 28304-6162
(910) 908-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P21047
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P21047
NORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS
NC
Enumeration date
03/30/2022
Last updated
03/30/2022
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