Amanda J Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05007177A Issued in IN

Practice address

1312 W Arch Haven Ave BLDG 1320
Suite E
Bloomington, IN 47403-2089

Phone

(812) 336-8406

Fax

(812) 336-8342

NPI assigned

Nov 15, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda J Warthan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: amanda.clark@iushc.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Indiana University

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1689790552
  NPD (past)

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1043554256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 W ARCH HAVEN AVE BLDG 1320",
            "address_2": "SUITE E",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032089",
            "telephone_number": "812-336-8406",
            "fax_number": "812-336-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05007177A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WARTHAN",
            "middle_name": "J",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven Wade Clapp, MD
• Matthew Howard Clardy, PMHNP
• Gail Padish Clarin, AU.D.
• Clariti Inc.
• Clark Brittain DO PC
• Christopher Anderson Clark, OD
• Gregory Scott Clark, LCSW
• Jared Michael Clark
• Jessica Clark
• Kayley Clark, RBT

• Physical Therapist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.

Verify at the official NPI Registry.