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NPI Code Detail

MEDICARE: GABRIEL M CLARK MPT

MEDICARE: GABRIEL M CLARK MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT011347OH
2225X00000XOccupational TherapistOT 5940OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1225100000XOTHEROHTAXONOMY CODE

General Provider Information

NPI Number : 1336113497
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL M CLARK MPT
Provider Business Mailing Address
First Line : 13020 N TELECOM PKWY
Second Line :
City : TEMPLE TERRACE
State : FL
Zip : 33637-0925
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-558-6187
Provider Business Practice Location Address
First Line : 909 N DALE MABRY HWY
Second Line : SUITE 300
City : TAMPA
State : FL
Zip : 33609-1251
Country : US
Telephone Number : 813-978-9700
Fax Number : 813-558-6187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 09/08/2015

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