Basic Information
| Provider Information | |||||||||
| NPI: | 1902304033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS-CLARKE | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 BALBOA BLVD UNIT 1002 | ||||||||
| Address2: | |||||||||
| City: | LAKE BALBOA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914063637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184300743 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 W ALAMEDA AVE | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915062932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189534444 | ||||||||
| FaxNumber: | 8189534940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 294061 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.