Active NPI
Timothy Albert Clark, LMT
- Massage Therapist
- Louisville, KY
National Provider Identifier
1013233477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- KY-2716
- Practice address
- 2010 Bonnycastle Ave Apt 1F
Louisville, KY 40205-1118 - Phone
- (502) 459-1557
- NPI assigned
- Apr 10, 2010
- Last updated
- Apr 10, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | KY-2716 | KY | Primary |
Addresses
Primary practice location
2010 Bonnycastle Ave Apt 1F
Louisville, KY 40205-1118
Mailing address
2010 Bonnycastle Ave Apt 1F
Louisville, KY 40205-1118
Phone (502) 459-1557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-2716 | KY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270857600000",
"number": "1013233477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2010 BONNYCASTLE AVE APT 1F",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402051118",
"telephone_number": "502-459-1557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 BONNYCASTLE AVE APT 1F",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402051118",
"telephone_number": "502-459-1557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "ALBERT",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-10",
"last_updated": "2010-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "KY",
"license": "KY-2716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.