Active NPI
Emmett Don Clark Jr., PTA
- Physical Therapy Assistant
- Conway, AR
National Provider Identifier
1154428456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1318
- Practice address
- 1500 Museum Rd Ste 104
Conway, AR 72032-4761 - Phone
- (501) 329-3804
- Fax
- (501) 329-0718
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 1318 | AR | Primary |
Addresses
Primary practice location
1500 Museum Rd Ste 104
Conway, AR 72032-4761
Mailing address
1500 Museum Rd Ste 104
Conway, AR 72032-4761
Phone (501) 329-3804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1318 | Other | AR | PTA 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1318 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154428456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 MUSEUM RD STE 104",
"city": "CONWAY",
"state": "AR",
"postal_code": "720324761",
"telephone_number": "501-329-3804",
"fax_number": "501-329-0718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 MUSEUM RD STE 104",
"city": "CONWAY",
"state": "AR",
"postal_code": "720324761",
"telephone_number": "501-329-3804",
"fax_number": "501-329-0718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "EMMETT",
"middle_name": "DON",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "1318",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "1318",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
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.