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General NPI Number Information
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NPI Number | 1790091361
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Entity Type | Individual
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Provider Name | LAUREN L CLARK DPT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 805 23RD ST APT B
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City | SANTA MONICA
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State | CA
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Zip | 90403-2185
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Country | US
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Telephone | 413-770-3018
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Fax |
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Provider Business Mailing Address
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Address Line | 805 23RD ST APT B
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City | SANTA MONICA
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State | CA
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Zip | 90403-2185
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Country | US
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Telephone | 413-770-3018
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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 | 070-018062
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License Number State | IL
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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 | 19780
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 293799
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License Number State | CA
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