Active NPI
Diane Maxine Clark, PT
- Physical Therapist
- Minnetonka, MN
National Provider Identifier
1306941166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1425
- Practice address
- 13560 Wayzata Blvd
Minnetonka, MN 55305-1850 - Phone
- (952) 525-1883
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | 1425 | MN | Primary |
Addresses
Primary practice location
13560 Wayzata Blvd
Minnetonka, MN 55305-1850
Mailing address
5760 Rosewood LN N
Plymouth, MN 55442-1411
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306941166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5760 ROSEWOOD LN N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554421411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13560 WAYZATA BLVD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051850",
"telephone_number": "952-525-1883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DIANE",
"middle_name": "MAXINE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "1425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.