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 1:2225 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3365
Mailing Address - Country:US
Mailing Address - Phone:775-359-1199
Mailing Address - Fax:775-359-1195
Practice Address - Street 1:2225 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3365
Practice Address - Country:US
Practice Address - Phone:775-359-1199
Practice Address - Fax:775-359-1195
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4575225100000X
NVNVMT.9396225700000X
HIMAT-13654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist