Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT5321 | NM |
NPI | 1033686316 |
---|---|
Provider Name | Clark Bearsmith |
First Address | Albuquerque, NM 87108-4317 |
Second Address | Albuquerque, NM 87122-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2018 |
Last Update Date | 25/10/2018 |