Keith Wayne Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2015517 Issued in TX

Practice address

406 S Main St
Winnsboro, TX 75494-3226

Phone

(903) 342-6790

Fax

(903) 342-6796

NPI assigned

May 1, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

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": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1346739737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 PAMELA DR",
            "city": "MINEOLA",
            "state": "TX",
            "postal_code": "757731327",
            "telephone_number": "903-363-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 S MAIN ST",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754943226",
            "telephone_number": "903-342-6790",
            "fax_number": "903-342-6796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KEITH",
        "middle_name": "WAYNE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-01",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "CP022392A",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NH",
            "license": "1445",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2015517",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VT",
            "license": "041.0134009",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "CP026481A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsea Alaine Chapman, COTA
• Rylie Chappell, PTA
• Celeste Charanza
• Robin Chouteau, PT
• Christus Trinity Clinic Texas
• Shelbi Dawn Cooper, FNP
• Rebecca Couch, NP
• Christopher Cowley
• John Robert Cox, PTA
• Troy Ray Crone Jr.

• Physical Therapy Assistant in Winnsboro, TX
• Providers in Winnsboro, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.