Active NPI
Andrea Clark, PT
- Physical Therapist
- Albany, CA
National Provider Identifier
1114359049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 19169
- Practice address
- 531 Madison St
Albany, CA 94706-1116 - Phone
- (510) 847-1496
- NPI assigned
- Aug 2, 2013
- Last updated
- Aug 2, 2013
- 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 | 19169 | CA | Primary |
Addresses
Primary practice location
531 Madison St
Albany, CA 94706-1116
Mailing address
531 Madison St
Albany, CA 94706-1116
Phone (510) 847-1496
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19169 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375401600000",
"number": "1114359049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "531 MADISON ST",
"city": "ALBANY",
"state": "CA",
"postal_code": "947061116",
"telephone_number": "510-847-1496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "531 MADISON ST",
"city": "ALBANY",
"state": "CA",
"postal_code": "947061116",
"telephone_number": "510-847-1496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANDREA",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-02",
"last_updated": "2013-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "19169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.