Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dusty Clark, PTA

Individual provider Physical Therapy Assistant · NPI 1306344163

Dusty Clark, PTA is a Physical Therapy Assistant in Glendale, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2018.

Licensed in
WI
In the registry since
2018
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

5333 N Port Washington Rd Ste B
Glendale, WI 53217-4914
Phone: (414) 716-1770
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 1880-19 (WI)

Record details

NPI number1306344163
Entity typeIndividual (Type 1)
GenderFemale
Credentials PTA
Sole proprietorNo
NPI enumeratedJanuary 26, 2018
Last updated in NPPESJuly 21, 2021
Certification dateJuly 21, 2021
Mailing address33900 Harper Ave Ste 104, Clinton Twp, MI 48035-4258

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