Conie Clark
Individual provider Active NPI Physical Therapy Assistant · Clarence, MO
NPI 1164098083 · NPPES record last updated Jun 1, 2021
Key facts
- NPI
- 1164098083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2020021602 (MO)
- Practice address
- 111 East St
Clarence, MO 63437-1902 - Phone
- (660) 699-2118
- NPI assigned
- Jun 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020021602 | MO | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2020021602 | MO | Yes |
Addresses
Primary practice location
111 East St
Clarence, MO 63437-1902
Mailing address
12864 Harvestor Ave
New Cambria, MO 63558-3135
Other providers in Clarence, MO
- Breath of Elegance LLC
- Jessica Renee Carroll
- Clarence Nursing Home District
- Creative Enterprises of Clarence
- Creative Enterprises of Clarence
- Johnston Drug Inc
- Bryce William Johnston
- James Johnston
All providers in Clarence, MO · Physical Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.