Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 02886 | IA |
NPI | 1023114576 |
---|---|
Provider Name | Steven Donald Clark |
First Address | Iowa City, IA 52246-4435 |
Second Address | Iowa City, IA 52246-4435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 20/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0665430 | (05) | IA |