Charles Clark, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-008359 Issued in IL

Practice address

1900 Ogden Ave
Aurora, IL 60504-4273

Phone

(630) 978-6218

Fax

(630) 978-6219

NPI assigned

Sep 26, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Yorkville Physical Therapy and Sports Medicine Center, LLC

  • Physical Therapist
  • Aurora, IL
  • NPI 1053365403
  NPD (past) Authorized official

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1245226141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 OGDEN AVE",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044273",
            "telephone_number": "630-978-6218",
            "fax_number": "630-978-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-008359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Beth Cirricione, M.S.
• Maritza C Ciszczon, MS OTR/L
• Alicia A. Citari, CRNA
• City of Aurora Illinois
• Timothy James Clare, DDS, MS
• Darlene Melissa Clark, M.S., ATC
• Doretha L Clark
• Sharon Redman Clark
• Stacia Clark
• Renae Clarke

• Physical Therapist in Aurora, IL
• Providers in Aurora, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.