NPIMap

Individual provider Active NPI

Rand J. Clark, P.T.

  • Physical Therapist
  • Twin Falls, ID
National Provider Identifier
1356596977
Registry record updated Nov 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
626 Issued in ID
Practice address
560 Shoup Ave W
Twin Falls, ID 83301-5029
Phone
(208) 737-2126
NPI assigned
Nov 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 626 ID Primary

Addresses

Primary practice location

560 Shoup Ave W
Twin Falls, ID 83301-5029

Mailing address

2093 Boulder Cir
Twin Falls, ID 83301-8344
Phone (208) 734-3429

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients
Family Physical Therapy & Sports Medicine Clinic Physical Therapist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1356596977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2093 BOULDER CIR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833018344",
            "telephone_number": "208-734-3429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 SHOUP AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015029",
            "telephone_number": "208-737-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RAND",
        "middle_name": "J.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-24",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; 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.