Charles Clark Jr., PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

003320 Issued in KY

Practice address

805 Blankenbaker Pkwy
Suite 107
Louisville, KY 40243-1894

Phone

(502) 253-0833

Fax

(502) 253-0834

NPI assigned

Jul 26, 2006

Last updated

Aug 13, 2019By the provider in NPPES

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 KY, IN2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Benchmark Physical Therapy of Ky LLCGroup PAC ID 0042577579, 55 clinicians

Agilitas USA, IncGroup PAC ID 3375454648, 812 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Benchmark Physical Therapy of Ky LLC

  • Physical Therapist
  • Chattanooga, TN
  • NPI 1043734221

  KY

  Medicare reassignment Care Compare group NPD
• Agilitas USA Inc

  dba Results Physiotherapy

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  IN, KY

  Medicare reassignment Care Compare group
• Agilitas USA Inc

  dba Results Physiotherapy

  • Physical Therapy Clinic/Center
  • Louisville, KY
  • NPI 1609117811
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1225052210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CRESCENT CENTRE DR STE 600",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677286",
            "telephone_number": "615-373-1350",
            "fax_number": "615-221-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 BLANKENBAKER PKWY",
            "address_2": "SUITE 107",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431894",
            "telephone_number": "502-253-0833",
            "fax_number": "502-253-0834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "003320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Gregory Clark
• Austin Roy Clark
• Bailey Clark, DO
• Brenda S. Clark, MS, LPCC, NCC
• Brian M Clark, O.D.
• Christina Blume Clark, M.D., PH.D.
• Courtney Clark
• David Clark
• Donald Patrick Clark Jr., PHARMD
• Eleanor Irene Clark, M.A., CCC-SLP

• Physical Therapist in Louisville, KY
• Providers in Louisville, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.