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General NPI Number Information
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NPI Number | 1790429074
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Entity Type | Individual
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Provider Name | ANTHONY G CLARK LMT
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Gender | Male
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 04/23/2022
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Provider Practice Location Address
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Address Line | 235 BELLMAN ST
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City | THROOP
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State | PA
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Zip | 18512-3304
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Country | US
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Telephone | 570-780-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 235 BELLMAN ST
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City | THROOP
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State | PA
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Zip | 18512-3304
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Country | US
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Telephone | 570-780-5858
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA-27231
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MSG003643
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License Number State | PA
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