Provider Demographics
NPI:1144958299
Name:LARK, ASHLEY SOPHIA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SOPHIA
Last Name:LARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10950 OMALLEY CENTRE DR STE D
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3000
Mailing Address - Country:US
Mailing Address - Phone:907-341-5240
Mailing Address - Fax:907-563-3460
Practice Address - Street 1:3801 LAKE OTIS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5234
Practice Address - Country:US
Practice Address - Phone:907-562-2277
Practice Address - Fax:907-563-3460
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK195453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1731699Medicaid