Dusty Clark, PTA

NPI #1306344163 in Glendale, Wisconsin

Provider Information

NPI Number: 1306344163
Entity Type: Individual
Name: Dusty Clark, PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Jan 26, 2018
Last Updated: Jul 21, 2021

Practice Location

Address: 5333 N PORT WASHINGTON RD STE B
City: Glendale
State: Wisconsin
ZIP Code: 53217-4914
Phone: (414) 716-1770

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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