Active NPI
Clark Brainerd, PT
- Physical Therapist
- Massillon, OH
National Provider Identifier
1013383926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT871879
- Practice address
- 8722 Glenarden Cir NW
Massillon, OH 44646-1600 - Phone
- (330) 685-4384
- NPI assigned
- Aug 14, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT871879 | DC | Primary |
Addresses
Primary practice location
8722 Glenarden Cir NW
Massillon, OH 44646-1600
Mailing address
3301 New Mexico Ave NW
Suite 318
Washington, DC 20016-3622
Phone (202) 363-0454
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT871879 | DC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447632000000",
"number": "1013383926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 NEW MEXICO AVE NW",
"address_2": "SUITE 318",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200163622",
"telephone_number": "202-363-0454",
"fax_number": "202-363-0668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8722 GLENARDEN CIR NW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446461600",
"telephone_number": "330-685-4384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAINERD",
"first_name": "CLARK",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-14",
"last_updated": "2015-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DC",
"license": "PT871879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.