Clark Physical Therapy & Bodywork, PLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

CLARK PHYSICAL THERAPY & BODYWORK, PLC

Practice address

614 Monkton Rd
Bristol, VT 05443-5392

Phone

(802) 349-1808

Fax

(802) 453-2988

NPI assigned

Jan 21, 2020

Last updated

Jan 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Anne Clark, PTNPI 1902900293

Title

Owner

Phone

(802) 349-1808

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly A Clark, PT

  • Physical Therapist
  • Bristol, VT
  • NPI 1902900293
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1093345811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SPLIT ROCK RD",
            "city": "NEW HAVEN",
            "state": "VT",
            "postal_code": "054722106",
            "telephone_number": "802-877-9929",
            "fax_number": "802-453-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 MONKTON RD",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054435392",
            "telephone_number": "802-349-1808",
            "fax_number": "802-453-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK PHYSICAL THERAPY & BODYWORK, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-349-1808",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6702477",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ClarkPTBodywork@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "614 Monkton Rd",
            "city": "Bristol",
            "state": "VT",
            "country_code": "US",
            "postal_code": "054435392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bristol Internal Medicine, PC
• Bristol Park Dental Associates PLC
• Bristol Rescue Squad, Inc.
• Teresa Marie Burns
• Chiropractic Health & Wellness PC
• Charles Edward Clark, MD
• Isabelle G Clark
• Kimberly A Clark, PT
• Michelle Cobb
• Brendan C Conroy, APRN

• Physical Therapy Clinic/Center in Bristol, VT
• Providers in Bristol, VT by specialty
• Physical Therapy Clinic/Center in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.