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General NPI Number Information
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NPI Number | 1861902736
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Entity Type | Organization
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Legal Business Name | CLARK ORTHOPEDIC REHABILITATION AND EDUCATION
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 1274 HONOKAHUA ST
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City | HONOLULU
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State | HI
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Zip | 96825-3019
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Country | US
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Telephone | 808-286-5005
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Fax | 808-286-5005
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Provider Business Mailing Address
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Address Line | PO BOX 240401
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City | HONOLULU
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State | HI
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Zip | 96824-0401
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Country | US
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Telephone | 808-286-5005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM CLARK
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Credential | ATC
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Telephone | 808-286-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-294
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License Number State | HI
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