James David Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1126 Issued in SC

Practice address

414 W Main St
Lake City, SC 29560-2318

Phone

(843) 374-7378

Fax

(843) 374-7379

NPI assigned

May 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Pee Dee Physical Therapy, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Lake City, SC
  • NPI 1225069040
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285845362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 WEST MAIN STREET",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602318",
            "telephone_number": "843-374-7378",
            "fax_number": "843-374-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 W MAIN ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602318",
            "telephone_number": "843-374-7378",
            "fax_number": "843-374-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAMES",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "1126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "1126",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolinas Medical Alliance Inc
• Carolinas Medical Alliance Inc (Carolinas Medical Alliance - Lake City Primary Care)
• Carolinas Medical Alliance, Inc (Lake City Medical Clinic)
• Christina Lynn Carter, PTA
• Lisa M Castles, P.A.
• Coastal Eye Group, P.C.
• Coastal Eye Group, P.C..
• Cofa, LLC
• Angela Coker
• Frances Merritt Coker, RN

• Physical Therapy Assistant in Lake City, SC
• Providers in Lake City, SC by specialty
• Physical Therapy Assistant in South Carolina

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.