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General NPI Number Information
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NPI Number | 1275041964
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Entity Type | Organization
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Legal Business Name | CLARK CONSULTING AND PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 8436 W 3RD ST STE 602
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City | LOS ANGELES
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State | CA
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Zip | 90048-4186
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Country | US
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Telephone | 323-596-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 26500 AGOURA RD # 102-135
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City | CALABASAS
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State | CA
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Zip | 91302-1952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN CLARK
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Credential | PT
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Telephone | 323-596-0603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 16701
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License Number State | CA
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