Provider Demographics
NPI:1083205629
Name:CLARK, MATTHEW AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AUSTIN
Last Name:CLARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:602-329-8250
Mailing Address - Fax:480-565-1898
Practice Address - Street 1:16611 S 40TH ST STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0564
Practice Address - Country:US
Practice Address - Phone:480-706-1199
Practice Address - Fax:480-706-3999
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist