Susanna Clark, PT, DPT, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL0013866 Issued in CO

Practice address

10450 Park Meadows Dr Ste 103
Lone Tree, CO 80124-5528

Phone

(303) 790-7877

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lone Peak Physical Therapy IncGroup PAC ID 5193637262, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

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.

• Lone Peak Physical Therapy Inc.

  dba Lone Peak Physical Therapy

  • Physical Therapist
  • Big Sky, MT
  • NPI 1477678969
  Medicare reassignment Care Compare group NPD
• Lone Peak Physical Therapy Inc

  • Durable Medical Equipment & Medical Supplies
  • Bozeman, MT
  • NPI 1740070564

  Physical Therapist

  NPD
• Lone Peak Physical Therapy, Inc.

  • Occupational Therapist
  • Bozeman, MT
  • NPI 1619305752

  Physical Therapist

  NPD
• Advanced Rehab, PC

  • Physical Therapist
  • Helena, MT
  • NPI 1780783506
  NPD (past)
• Effingham Rehab Services, LLC

  dba CORA Physical Therapy - Brunswick

  • Rehabilitation Clinic/Center
  • Brunswick, GA
  • NPI 1366016032
  NPD (past)
• Effingham Rehab Services, LLC

  • Rehabilitation Clinic/Center
  • Rincon, GA
  • NPI 1639137128

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1366713521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 PARK MEADOWS DR STE 103",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245528",
            "telephone_number": "303-790-7877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 PARK MEADOWS DR STE 103",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245528",
            "telephone_number": "303-790-7877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUSANNA",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, OCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0013866",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT010027",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Church
• Jonathan Hugh Churchill, P.A.
• Amanda Dianne Clark, AUD
• Kelly Noelle Clark, FNP
• Larry K Clark, MD
• Keith Edward Clear, DDS, MS
• Daniel Brian Cleveland, OD
• Clinical Care 365 Inc
• Cliniconcall.Org
• Bryan Clippinger

• Physical Therapist in Lone Tree, CO
• Providers in Lone Tree, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.