Healthcare Provider Details

I. General information

NPI: 1114844891
Provider Name (Legal Business Name): JAMES CLARK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST STE 400
SAN FRANCISCO CA
94158-2335
US

IV. Provider business mailing address

1500 OWENS ST STE 400
SAN FRANCISCO CA
94158-2335
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: