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

Mr. Clarke Maverick Hiserodt

Individual provider Physical Therapy Assistant · NPI 1417540030

Mr. Clarke Maverick Hiserodt is a Physical Therapy Assistant in Burbank, California. Practices as a sole proprietor and works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2021
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Practice location Address checks out

1819 N Brighton St
Burbank, CA 91506-1005
Phone: (818) 263-0790
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2110 Zocolo St Apt 140, Oxnard, CA 93036-3764 — (818) 263-0790

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 50686 (CA)

Record details

NPI number1417540030
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 15, 2021
Last updated in NPPESJune 24, 2021
Certification dateJune 24, 2021

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