Active NPI
Julie Clark, MSPT
- Physical Therapist
- Grand Haven, MI
National Provider Identifier
1104328442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501009461
- Practice address
- 14929 Sandstone PL
Grand Haven, MI 49417-7947 - Phone
- (231) 327-9578
- NPI assigned
- Mar 2, 2018
- Sex
- Female
- 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 | 5501009461 | MI | Primary |
Addresses
Primary practice location
14929 Sandstone PL
Grand Haven, MI 49417-7947
Mailing address
14929 Sandstone PL
Grand Haven, MI 49417-7947
Other practice location 1
625 Kenmoor Ave SE Ste 306
Grand Rapids, MI 49546-2395
Phone (616) 942-5744
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306876438 | Medicaid | MI |
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 |
|---|---|---|---|
| 5501009461 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1104328442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14929 SANDSTONE PL",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494177947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14929 SANDSTONE PL",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494177947",
"telephone_number": "231-327-9578"
}
],
"practiceLocations": [
{
"address_1": "625 Kenmoor Ave SE Ste 306",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495462395",
"country_code": "US",
"telephone_number": "616-942-5744",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "JULIE",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-02",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501009461",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306876438",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
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- Christian Haven Home
- Anna Eileen Ciarlino, ATC
- Sydney Tressler Cinal, DDS
- Clarity Health Services (Comprehensive Ear and Hearing of Grand Haven)
- Cmbi3 PLLC (Grand Haven Pediatric Dentistry)
- Mary L Cole, RD
- Comforcare Senior Services - Grand Haven
- Compassionate Christian Therapy, LLC
- Confidence Beyond Hair Loss
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.