Provider Demographics
NPI:1629405568
Name:CLARK FITNESS TRAINING, LLC
Entity Type:Organization
Organization Name:CLARK FITNESS TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-771-3343
Mailing Address - Street 1:60 TILTON DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3360
Mailing Address - Country:US
Mailing Address - Phone:732-771-3343
Mailing Address - Fax:732-625-7867
Practice Address - Street 1:60 TILTON DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3360
Practice Address - Country:US
Practice Address - Phone:732-771-3343
Practice Address - Fax:732-625-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01506500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy