Healthcare Provider Details

I. General information

NPI: 1700715836
Provider Name (Legal Business Name): MATTHEW RAY CLARK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 STATE HIGHWAY 97 SUITE 200
SAND SPRINGS OK
74063
US

IV. Provider business mailing address

3300 STATE HIGHWAY 97 SUITE 200
SAND SPRINGS OK
74063
US

V. Phone/Fax

Practice location:
  • Phone: 539-527-0045
  • Fax:
Mailing address:
  • Phone: 539-527-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6863
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: