Individual provider Active NPI

Amy Clark, MPT

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1265542740
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1151652 Issued in TX
Practice address
6037 Harris Pkwy
Fort Worth, TX 76132-4103
Phone
(817) 370-9891
Fax
(817) 370-9894
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1151652 TX Primary

Addresses

Primary practice location

6037 Harris Pkwy
Fort Worth, TX 76132-4103

Mailing address

6037 Harris Pkwy
Fort Worth, TX 76132-4103
Phone (817) 370-9891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200107002381 TX Practitioner - Physical Therapist in Private Practice 8325472970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sportherapy LLCGroup PAC ID 0749536308, 45 clinicians

Practice addresses (Care Compare)

6501 Harris Pkwy
Fort Worth, TX 76132-6102
Phone (817) 370-9891

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1151652TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sportherapy LLC Physical Therapist CurrentSince Sep 1, 2019 Accepting new patients
Sportherapy Southwest, PC Physical Therapist PastSince Sep 1, 2019 Accepting new patients

Locations

245 W Main St
Azle, TX 76020
Phone (817) 270-2975

7630 N Beach St
Ste 180
Fort Worth, TX 76137
Phone (682) 428-9900

6037 Harris Pkwy
Fort Worth, TX 76132
Phone (817) 294-2800

965 Hilltop Dr
Weatherford, TX 76086
Phone (817) 370-9891

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265542740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6037 HARRIS PKWY",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324103",
            "telephone_number": "817-370-9891",
            "fax_number": "817-370-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6037 HARRIS PKWY",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324103",
            "telephone_number": "817-370-9891",
            "fax_number": "817-370-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMY",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1151652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.