Healthcare Provider Details

I. General information

NPI: 1114821766
Provider Name (Legal Business Name): ROBERT CLARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2626 STONEBROOK PKWY STE 500
FRISCO TX
75034-1394
US

IV. Provider business mailing address

5400 RUNNING BROOK LN
MCKINNEY TX
75071-7731
US

V. Phone/Fax

Practice location:
  • Phone: 469-252-0433
  • Fax:
Mailing address:
  • Phone: 469-636-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2188421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: