Roger Clark, ATC, PhD
Specialist/Technologist, Athletic Trainer in Pueblo, CO. Individual provider (NPI-1).
NPI number1225458136
StatusActive
Last updated in NPPESApr 17, 2014
Details
- NPI
- 1225458136
- Entity type
- Individual (NPI-1)
- Name
- Prof. Roger Clark
- Credential
- ATC, PhD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 17, 2014
- Last updated
- Apr 17, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 627 | CO | Yes |
Practice location
2200 Bonforte BlvdPueblo, CO 81001-4901
Phone 719-549-2530 · Fax 719-549-2549
Mailing address
2200 Bonforte BlvdPueblo, CO 81001-4901
Phone 719-549-2530 · Fax 719-549-2549
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All 35 Athletic Trainer providers in Pueblo · All 5,060 providers in Pueblo
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