Kimberley Ann Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

024674 Issued in NY

Practice address

5415 County Road 30
Canandaigua, NY 14424-7964

Phone

(585) 394-9510

NPI assigned

Oct 15, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberley Ann Brhel Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clark Physical Therapy PCGroup PAC ID 3678838323, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Clark Physical Therapy, P.C.

  • Physical Therapy Clinic/Center
  • Webster, NY
  • NPI 1124542170
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224028800000",
    "number": "1225280886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 PRINCETON LN",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "144509027",
            "telephone_number": "585-598-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 COUNTY ROAD 30",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144247964",
            "telephone_number": "585-394-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLEY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-15",
        "last_updated": "2008-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "024674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLEY",
            "last_name": "BRHEL",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melvyn Chin, MD
• Khamkay Chitaphong, LMSW
• Chosen Spot Chiropractic & Wellness PLLC
• Kathleen May Church, DC
• Andrew Cieri, DC
• Clemensen Family Medicine
• Melissa Cleveland, LPN
• John Evis Coda, MD
• Karen F Coffey, RD
• Katherine Coffey

• Physical Therapist in Canandaigua, NY
• Providers in Canandaigua, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; 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.