Provider Demographics
NPI:1679975858
Name:CLARK, CHRIS (ATC)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:CLARK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2739
Mailing Address - Country:US
Mailing Address - Phone:510-301-0059
Mailing Address - Fax:925-954-1839
Practice Address - Street 1:1 FALCON CT
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2739
Practice Address - Country:US
Practice Address - Phone:510-301-0059
Practice Address - Fax:925-954-1839
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer