Joel Ellis Clark, P.T.
Individual provider Active NPI Physical Therapist · Wilmore, KY
NPI 1366617243 · NPPES record last updated Apr 23, 2008
Key facts
- NPI
- 1366617243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 005026 (KY)
- Practice address
- 107 Rabbit TRL
Wilmore, KY 40390-1481 - Phone
- (859) 321-2741
- NPI assigned
- Apr 23, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005026 | KY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 005026 | KY | Yes |
Addresses
Primary practice location
107 Rabbit TRL
Wilmore, KY 40390-1481
Mailing address
107 Rabbit TRL
Wilmore, KY 40390-1481
Phone (859) 321-2741
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP-224 | Medicaid | KY |
Other providers in Wilmore, KY
- Katelyn E Bailey
- Sarah Beeghly
- Mallory M Bitterman
- John Norwood Chapman
- Christopher Alex Clark
- Thomas Fred Coburn
- Rebecca R Cole
- Commonwealth of Kentucky
- Compass Center
- Celesta Lee Cusick
All providers in Wilmore, KY · Physical Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.