Individual
MR. MICHAEL D CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1200 W CHEROKEE ST, WAGONER, OK 74467-4624
(918) 485-1323
(918) 485-9486
Mailing address
606 E WILLOW DR, WAGONER, OK 74467-1618
(918) 485-8686
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2492
OK
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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