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NPI Code Detail

MEDICARE: BRETT H CLARK PT

MEDICARE: BRETT H CLARK PT
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 TherapistGA

General Provider Information

NPI Number : 1902663453
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRETT H CLARK PT
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : FORTSON
State : GA
Zip : 31808-0370
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6262 VETERANS PKWY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-3540
Country : US
Telephone Number : 706-324-6661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2024
Last Update Date : 06/04/2026

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