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BRIAN KEITH CLARK PTA

>> Physical Therapy Assistant >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1679801286

Individual Registrant:
 BRIAN KEITH CLARK PTA
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1407 MELBOURNE ST  FOSTER CITY, CA 94404-3960 US
Tel: 650-759-1872  Fax: --

Contact information for business:
1407 MELBOURNE ST  FOSTER CITY, CA 94404-3960 US
Tel: 650-759-1872  Fax: --

Registration Information:
NPI: 1679801286
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225200000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapy Assistant
CAAT 2497

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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