Organization Active NPI

Purpose Physical Therapy and Wellness, LLC

  • Orthopedic Physical Therapist
  • St Petersburg, FL
National Provider Identifier
1003422064
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
PURPOSE PHYSICAL THERAPY AND WELLNESS, LLC
Practice address
1212 66TH St N Ste 1214
St Petersburg, FL 33710-6226
Phone
(417) 315-5577
Fax
(727) 290-4917
NPI assigned
Sep 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth John Clark Jr., DPTNPI 1144740580
Title
Owner/Ceo
Phone
(417) 315-5577

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X Primary

Addresses

Primary practice location

1212 66TH St N Ste 1214
St Petersburg, FL 33710-6226

Mailing address

1212 66TH St N Ste 1214
St Petersburg, FL 33710-6226
Phone (417) 315-5577

Other names 1

  • Purpose Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230303000851 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9931572435 Receives reassigned benefits from 3 practitioners
Practice locations: South Pasadena, FL; St Petersburg, FL

National Provider Directory

National Provider Directory

Locations

724 Pasadena Ave S
South Pasadena, FL 33707
Phone (417) 315-5577

1212 66th St N
Ste 1214
St Petersburg, FL 33710

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1003422064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 66TH ST N STE 1214",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106226",
            "telephone_number": "417-315-5577",
            "fax_number": "727-290-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 66TH ST N STE 1214",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337106226",
            "telephone_number": "417-315-5577",
            "fax_number": "727-290-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURPOSE PHYSICAL THERAPY AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "417-315-5577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Purpose Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Purpose Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.