Provider Demographics
NPI:1740514462
Name:CLARK, HELEN BURK (PT)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:BURK
Last Name:CLARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:MATHILDA
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:758 216TH DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-7520
Mailing Address - Country:US
Mailing Address - Phone:515-275-4003
Mailing Address - Fax:515-275-4122
Practice Address - Street 1:758 216TH DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IA
Practice Address - Zip Code:50212-7520
Practice Address - Country:US
Practice Address - Phone:515-275-4003
Practice Address - Fax:515-275-4122
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist