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General NPI Number Information
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NPI Number | 1578293114
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Entity Type | Individual
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Provider Name | DYLAN EDWARD CLARK PT
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 6565 ARLINGTON BLVD STE 220
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3000
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Country | US
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Telephone | 703-942-8824
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Fax | 703-942-8834
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Provider Business Mailing Address
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Address Line | 3 HOBBES CT
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City | MEDFORD
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State | NJ
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Zip | 08055-3945
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Country | US
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Telephone | 609-367-3533
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Fax |
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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 | 2305215327
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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