Wesley Ethan Clark, PT
Physical Therapist in Desoto, TX. Individual provider (NPI-1).
NPI number1730118381
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1730118381
- Entity type
- Individual (NPI-1)
- Name
- Wesley Ethan Clark
- Credential
- PT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 3, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 1142982 | TX | Yes |
Practice location
931 York DrSuite A
Desoto, TX 75115-2043
Phone 972-296-6645 · Fax 972-296-4526
Mailing address
931 York DrSuite A
Desoto, TX 75115-2043
Phone 972-296-6645 · Fax 972-296-4526
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