Individual
BRYAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
109 WILSON AVE, MORGANTOWN, WV 26501-7521
(304) 291-9260
Mailing address
8010 KAUSTIN DR, MORGANTOWN, WV 26501-7210
(719) 760-9747
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001719
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000021913
BOARD OF CERTIFICATION
—
01
—
AT001719
WEST VIRGINIA LICENSURE
WV
Enumeration date
09/24/2021
Last updated
09/24/2021
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