Provider Demographics
NPI:1063414464
Name:CLARK, STEVEN R (PT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:CLARK
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Gender:M
Credentials:PT
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Mailing Address - Street 1:330 1ST STREET, SUITE 100
Mailing Address - Street 2:STEVEN CLARK MFR PHYSICAL THERAPY
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265
Mailing Address - Country:US
Mailing Address - Phone:515-277-6032
Mailing Address - Fax:515-277-1356
Practice Address - Street 1:330 1ST STREET, SUITE 100
Practice Address - Street 2:STEVEN CLARK MFR PHYSICAL THERAPY
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265
Practice Address - Country:US
Practice Address - Phone:515-277-6032
Practice Address - Fax:515-277-1356
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2017-12-04
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Provider Licenses
StateLicense IDTaxonomies
IA00768225100000X
IA768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q17908Medicare UPIN