Clark, Michael J
Clark, Michael J is an individual health care provider with primary practice located at 275 W Tietan St , Walla Walla WA 99362-4363. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Clark, Michael J can be contacted via phone (509) 522-0114.Contact Information
Primary practice address
275 W Tietan St
Walla Walla WA 99362-4363
Phone: (509) 522-0114
Fax: (509) 522-9868
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 2569 | Oregon |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT00005772 | Washington |
Profile Details
| NPI number | 1306849955 |
|---|---|
| LBN Legal business name | Clark, Michael J |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2005 |
| Last updated | Sep 15th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306849955 | NPPES |
| Washington | Other | 650011919 | RAILROAD MEDICARE |
| Washington | Other | 0766690001 | RAILROAD MEDICARE |
| Washington | Other | 108672 | RAILROAD MEDICARE |
| Washington | MEDICAID | 8348476 | RAILROAD MEDICARE |
| Washington | Other | CL5823 | RAILROAD MEDICARE |
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