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General NPI Number Information
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NPI Number | 1235090119
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Entity Type | Individual
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Provider Name | BENJAMIN CLARK DPT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 1309 HARBOR AVE SW STE A
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City | SEATTLE
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State | WA
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Zip | 98116-1784
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Country | US
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Telephone | 206-906-9207
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Fax | 206-906-9369
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Provider Business Mailing Address
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Address Line | 1309 HARBOR AVE SW STE A
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City | SEATTLE
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State | WA
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Zip | 98116-1784
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Country | US
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Telephone | 206-906-9207
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Fax | 206-906-9369
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT70034123
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License Number State | WA
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