Active NPI
Elizabeth Clark
- Physical Therapy Assistant
- San Antonio, TX
National Provider Identifier
1053526939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2009924
- Practice address
- 5101 Medical Dr
San Antonio, TX 78229-4801 - Phone
- (210) 592-5438
- NPI assigned
- May 13, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2009924 | TX | Primary |
Addresses
Primary practice location
5101 Medical Dr
San Antonio, TX 78229-4801
Mailing address
5368 Fredericksburg Rd
Suite 200
San Antonio, TX 78229-6108
Phone (210) 349-0096
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 |
|---|---|---|---|
| 2009924 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053526939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5368 FREDERICKSBURG RD",
"address_2": "SUITE 200",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782296108",
"telephone_number": "210-349-0096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5101 MEDICAL DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782294801",
"telephone_number": "210-592-5438"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2009924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.