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General NPI Number Information
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NPI Number | 1952329112
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Entity Type | Individual
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Provider Name | PEGGY CLARK PT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 2751 W 120TH AVE STE 200
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City | WESTMINSTER
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State | CO
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Zip | 80234-2979
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Country | US
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Telephone | 303-465-6332
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Fax |
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Provider Business Mailing Address
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Address Line | 1594 ASTER CT
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City | SUPERIOR
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State | CO
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Zip | 80027-6032
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Country | US
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Telephone | 720-312-8332
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 3299
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License Number State | CO
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