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General NPI Number Information
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NPI Number | 1790850758
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Entity Type | Individual
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Provider Name | TODD K A CLARK MSPT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 1090 KEOLU DR SUITE 104
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City | KAILUA
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State | HI
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Zip | 96734-3871
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Country | US
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Telephone | 808-262-2292
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Fax | 808-262-2293
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Provider Business Mailing Address
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Address Line | PO BOX 1440
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City | KAILUA
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State | HI
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Zip | 96734-1440
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Country | US
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Telephone | 808-262-2292
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Fax | 808-262-2293
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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 | 1978
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License Number State | HI
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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 | PT1978
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License Number State | HI
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