Provider Demographics
NPI:1972263713
Name:BECK, CLARK JOSEPH ELLISON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:JOSEPH ELLISON
Last Name:BECK
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 1:1402 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84087-1861
Mailing Address - Country:US
Mailing Address - Phone:385-489-4013
Mailing Address - Fax:
Practice Address - Street 1:1402 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84087-1861
Practice Address - Country:US
Practice Address - Phone:385-489-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist