Active NPI
Benjamin Clark
- Physical Therapist
- Shallotte, NC
National Provider Identifier
1285189704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16530
- Practice address
- 4501 Main St Ste 5
Shallotte, NC 28470-4585 - Phone
- (910) 755-5863
- NPI assigned
- Aug 25, 2016
- Last updated
- Aug 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 16530 | NC | Primary |
Addresses
Primary practice location
4501 Main St Ste 5
Shallotte, NC 28470-4585
Mailing address
4501 Main St Ste 5
Shallotte, NC 28470-4585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16530 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas Speech Therapy Services PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Speech-Language Pathologist
- Supply, NC
- NPI 1871860544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472083200000",
"number": "1285189704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 MAIN ST STE 5",
"city": "SHALLOTTE",
"state": "NC",
"postal_code": "284704585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4501 MAIN ST STE 5",
"city": "SHALLOTTE",
"state": "NC",
"postal_code": "284704585",
"telephone_number": "910-755-5863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BENJAMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-25",
"last_updated": "2016-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "16530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shallotte, NC
- Ashley Kilpatrick Chauncey, LCMHC
- Cynthia Marlowe Cheers, LPC, NCC
- Chicora Medical Group PA
- Allison Anna Chouinard
- Leanne Nicole Christian, LPC
- Coastal Carolina Chiropractic (Coastal Integrative Health)
- Coastal Carolina Chiropractic (Coastal Integrative Health)
- Coastal Carolina Home Care, LLC
- Coastal Comfort Home Care LLC (Coastal Comfort Home Care)
- Coastal Horizons Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.