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NPI Code Detail

MEDICARE: MR. ZACHARY ALEXANDER CLARK PT, DPT, LMT

MEDICARE: MR. ZACHARY ALEXANDER CLARK PT, DPT, LMT
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
1225700000XMassage TherapistNVMT.9396NV
2225100000XPhysical Therapist4575NV
3225700000XMassage TherapistMAT-13654HI

General Provider Information

NPI Number : 1790169225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ZACHARY ALEXANDER CLARK PT, DPT, LMT
Provider Business Mailing Address
First Line : 2225 N MCCARRAN BLVD
Second Line :
City : SPARKS
State : NV
Zip : 89431-3365
Country : US
Telephone Number : 775-359-1199
Fax Number : 775-359-1195
Provider Business Practice Location Address
First Line : 2225 N MCCARRAN BLVD
Second Line :
City : SPARKS
State : NV
Zip : 89431-3365
Country : US
Telephone Number : 775-359-1199
Fax Number : 775-359-1195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2015
Last Update Date : 06/15/2026

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