Provider Demographics
NPI:1902304033
Name:ADAMS-CLARKE, TARA YVONNE (DPT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:YVONNE
Last Name:ADAMS-CLARKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 BALBOA BLVD UNIT 1002
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3637
Mailing Address - Country:US
Mailing Address - Phone:818-430-0743
Mailing Address - Fax:
Practice Address - Street 1:2001 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2932
Practice Address - Country:US
Practice Address - Phone:818-953-4444
Practice Address - Fax:818-953-4940
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist