MR. Charles Warren Clark JR., LMT

NPI #1811290935 in Montgomery, Texas

Provider Information

NPI Number: 1811290935
Entity Type: Individual
Name: MR. Charles Warren Clark JR., LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: Dec 11, 2010
Last Updated: Dec 11, 2010

Practice Location

Address: 19577 FM 2854 RD
City: Montgomery
State: Texas
ZIP Code: 77316-3150
Phone: (936) 537-0948

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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