Joseph Brady Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-012200 Issued in AZ

Practice address

1030 Scott Dr
Prescott, AZ 86301-4737

Phone

(928) 778-2450

NPI assigned

Oct 21, 2020

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1164021093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 CAMPBELL ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012521",
            "telephone_number": "928-830-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SCOTT DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014737",
            "telephone_number": "928-778-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOSEPH",
        "middle_name": "BRADY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "PTA-012200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adryanna B Ciera, LMT
• Richard Allen Cirelli, M.D
• Clarity Lab LLC
• John Clarizio, LMSW
• Jessica Lee Clark, PT, DPT
• Marylyn Ann Clark, PH D
• William Clark
• Catherine Elizabeth Clark/Verlinde, L.M.T.
• Kathleen Carey Clarkin-Dedio, DC
• Claussen Collaborative Medical Clinic LLC

• Physical Therapy Assistant in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.