Active NPI
Brian Howard Clark, PT
- Physical Therapist
- Sheffield, AL
National Provider Identifier
1114063245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTH3211
- Practice address
- 1300 S Montgomery Ave
Sheffield, AL 35660-6334 - Phone
- (256) 386-4005
- Fax
- (256) 386-4685
- NPI assigned
- Jan 29, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH3211 | AL | Primary |
Addresses
Primary practice location
1300 S Montgomery Ave
Sheffield, AL 35660-6334
Mailing address
2101 Virginia Ave
Muscle Shoals, AL 35661-2633
Phone (256) 314-0491
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51513137 | Other | AL | BLUE CROSS |
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 |
|---|---|---|---|
| PTH3211 | AL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114063245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 VIRGINIA AVE",
"city": "MUSCLE SHOALS",
"state": "AL",
"postal_code": "356612633",
"telephone_number": "256-314-0491",
"fax_number": "256-386-4067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S MONTGOMERY AVE",
"city": "SHEFFIELD",
"state": "AL",
"postal_code": "356606334",
"telephone_number": "256-386-4005",
"fax_number": "256-386-4685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRIAN",
"middle_name": "HOWARD",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH3211",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "51513137",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sheffield, AL
- Madison Taylor Chastain, CRNP
- Jose Claudio Chaves, MD
- Lisa M Christian, MD
- Christopher P Gay Medical Services (Dr Christopher Gay Family Practice)
- Brittney Wylie Clanton, RN
- Stanley D Clarke, M.D.
- Justin Keith Coan, CRNP
- Colbert County Health Department - Child Health
- Colbert County Health Department - Epsdt
- Colbert County Health Dept Adult Immun
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.