Provider Demographics
NPI:1831318773
Name:CLARK, JAMES H (PT CA PT12479)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:CLARK
Suffix:
Gender:M
Credentials:PT CA PT12479
Other - Prefix:
Other - First Name:J H
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT CA PT12479
Mailing Address - Street 1:903 CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245
Mailing Address - Country:US
Mailing Address - Phone:559-924-5823
Mailing Address - Fax:
Practice Address - Street 1:5180 N PALM
Practice Address - Street 2:STE 102 CAREER STAFF UNLIMITED OFFICE
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704
Practice Address - Country:US
Practice Address - Phone:559-264-0394
Practice Address - Fax:559-244-0425
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist