KEITH ANTHONY CLARK
NPI 1114453933
Massage Therapist in Dallas, TX
- Individual
- Male
- Massage Therapist
About KEITH CLARK
This page provides the complete NPI Profile along with additional information for Keith Clark, a provider established in Dallas, Texas with a medical specialization in Massage Therapist. The healthcare provider is registered in the NPI registry with number 1114453933 assigned on May 2017. The practitioner's primary taxonomy code is 225700000X with license number MT111749 (TX). The provider is registered as an individual and his NPI record was last updated 9 years ago.
- NPI
- 1114453933 Verify this NPI
- Provider Name
- KEITH ANTHONY CLARK
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 11311 N CENTRAL EXPY STE 211 DALLAS, TX 75243
- Location Phone
- (214) 315-2959
- Mailing Address
- PO BOX 273326 FORT COLLINS, CO 80527
- Mailing Phone
- (866) 996-2772
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 05-11-2017
- Last Update Date
- 05-11-2017
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Massage Therapist
- Taxonomy Code
- 225700000X
- Type
- Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- License No.
- MT111749
- License State
- TX
- Taxonomy Description
- An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114453933, enumerated as an "individual" on May 11, 2017.
The provider is located at 11311 N CENTRAL EXPY STE 211 DALLAS, TX 75243 and the phone number is (214) 315-2959.
Massage Therapist with taxonomy code 225700000X.
