Active NPI
Jon Clark
- Physical Therapist
- Raleigh, NC
National Provider Identifier
1134580376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 2932 Sunnystone Way
Raleigh, NC 27613-6192 - Phone
- (919) 906-8310
- NPI assigned
- Mar 16, 2016
- 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 | Primary |
Addresses
Primary practice location
2932 Sunnystone Way
Raleigh, NC 27613-6192
Mailing address
2932 Sunnystone Way
Raleigh, NC 27613-6192
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12345678 | Other | STATE LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458086400000",
"number": "1134580376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2932 SUNNYSTONE WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276136192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2932 SUNNYSTONE WAY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276136192",
"telephone_number": "919-906-8310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-16",
"last_updated": "2016-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "12345678",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.