Active NPI
Paul Clark
- Recreation Therapist
- Salt Lake City, UT
National Provider Identifier
1013766690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 9129425-4003
- Practice address
- 451 E Bishop Federal LN
Salt Lake City, UT 84115-2357 - Phone
- (801) 487-7557
- NPI assigned
- May 15, 2024
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 9129425-4003 | UT | Primary |
Addresses
Primary practice location
451 E Bishop Federal LN
Salt Lake City, UT 84115-2357
Mailing address
9956 S Blossom Dr
Sandy, UT 84092-3614
Phone (385) 436-0546
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 |
|---|---|---|---|
| 9129425-4003 | UT | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1013766690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9956 S BLOSSOM DR",
"city": "SANDY",
"state": "UT",
"postal_code": "840923614",
"telephone_number": "385-436-0546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 E BISHOP FEDERAL LN",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841152357",
"telephone_number": "801-487-7557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-15",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "UT",
"license": "9129425-4003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.