Healthcare Provider Details

I. General information

NPI: 1700274628
Provider Name (Legal Business Name): DREW CLARK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD SUITE 310
LOS ANGELES CA
90035-1613
US

IV. Provider business mailing address

8665 WILSHIRE BLVD BLDG SUITE303
BEVERLY HILLS CA
90211-2975
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-0882
  • Fax:
Mailing address:
  • Phone: 310-360-9069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: