Provider Demographics
NPI:1669838736
Name:CLARKE, MICHAEL HENRY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 BELL NORTH DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3470
Mailing Address - Country:US
Mailing Address - Phone:888-590-4002
Mailing Address - Fax:
Practice Address - Street 1:17325 BELL NORTH DR.
Practice Address - Street 2:SUITE 2-B
Practice Address - City:SHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:888-590-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1270089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist