Provider Demographics
NPI:1790169225
Name:CLARK, ZACHARY ALEXANDER (PT, DPT, LMT)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ALEXANDER
Last Name:CLARK
Suffix:
Gender:M
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2503
Mailing Address - Country:US
Mailing Address - Phone:702-263-3802
Mailing Address - Fax:
Practice Address - Street 1:8333 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2503
Practice Address - Country:US
Practice Address - Phone:702-263-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.9396225700000X
HIMAT-13654225700000X
NV4575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist