Kenneth John Clark Jr., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT32691 Issued in FL

Practice address

6619 1St Ave S
Saint Petersburg, FL 33707-1305

Phone

(417) 315-5577

NPI assigned

Jun 27, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Purpose Physical Therapy and Wellness LLCGroup PAC ID 9931572435, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Purpose Physical Therapy and Wellness, LLC

  • Orthopedic Physical Therapist
  • St Petersburg, FL
  • NPI 1003422064
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1144740580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 28TH AVE N",
            "address_2": "1/2",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337041205",
            "telephone_number": "417-315-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6619 1ST AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337071305",
            "telephone_number": "417-315-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT32691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred Elton Clark III, M.D.
• Gail E Clark, LCSW
• James Michael Clark, RPH
• Jonathan Andrew Clark, APRN
• Karen Yvette Clark, M.S.
• Masharia Ann Clark, ARNP
• Roy George Clark, DMD
• Thomas G. Clark, D.C.
• Victoria Isabelle Clark, LMHC
• Carolyn Marie Clarke, ARNP

• Physical Therapist in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.