Brian Keith Clark, PTA
Individual provider Active NPI Physical Therapy Assistant · Foster City, CA
NPI 1679801286 · NPPES record last updated Nov 20, 2009
Key facts
- NPI
- 1679801286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- AT 2497 (CA)
- Practice address
- 1407 Melbourne St
Foster City, CA 94404-3960 - Phone
- (650) 759-1872
- NPI assigned
- Nov 20, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT 2497 | CA | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | AT 2497 | CA | Yes |
Addresses
Primary practice location
1407 Melbourne St
Foster City, CA 94404-3960
Mailing address
1407 Melbourne St
Foster City, CA 94404-3960
Phone (650) 759-1872
Other providers in Foster City, CA
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- Chme Pharmacy LLC
- Edwin Chu
- Maria Chui
- Michael Chung
- Christopher Michael Colgin
- Janis Gilbert Cooper
- Costco Wholesale Corporation
- Costco Wholesale Corporation
- Costco Wholesale Corporation
All providers in Foster City, CA · Physical Therapy Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.