Elaine M Clark, MPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT00000762 Issued in WA

Practice address

710 NW Juniper St
Issaquah, WA 98027-2717

Phone

(425) 392-7989

NPI assigned

Oct 15, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295825511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 E MCGRAW ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981122633",
            "telephone_number": "206-726-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 NW JUNIPER ST",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272717",
            "telephone_number": "425-392-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELAINE",
        "middle_name": "M",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "WA",
            "license": "PT00000762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7038649",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audrey Jean Church, ARNP
• Artem Chuvashov, DDS
• Yelena Chuvashova, DDS
• Caroline Ciesko
• Nicole Citragno
• Scott Clayhold, DMD, MDS
• Tiffany Dawn Cloud, OT
• Julie Clouse
• Jaime Cloyd
• Sabino Emil Cocos, PT, DPT, OCS

• Pediatric Physical Therapist in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Pediatric Physical Therapist in Washington

• 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.