Clark, Geoffrey Wayne

Clark, Geoffrey Wayne is an individual health care provider with primary practice located at 7325 Sw Childs Rd , Portland OR 97224-7713. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Clark, Geoffrey Wayne can be contacted via phone (503) 797-9812.

Contact Information

Primary practice address
7325 Sw Childs Rd Portland OR 97224-7713
Phone: (503) 797-9812
Fax: (503) 797-9996
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X AT-AT-908663 Oregon

Profile Details

NPI number 1790751600
LBN Legal business name Clark, Geoffrey Wayne
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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