Active NPI
Ralph Clark, LMT
- Massage Therapist
- Saint Charles, MO
National Provider Identifier
1366720799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2008022372
- Practice address
- 7300 Fox Chase Dr
Saint Charles, MO 63301-8360 - Phone
- (314) 546-7517
- NPI assigned
- Aug 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 2008022372 | MO | Primary |
Addresses
Primary practice location
7300 Fox Chase Dr
Saint Charles, MO 63301-8360
Mailing address
7300 Fox Chase Dr
Saint Charles, MO 63301-8360
Phone (314) 546-7517
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2008022372 | Medicaid | MO |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008022372 | MO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1366720799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7300 FOX CHASE DR",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633018360",
"telephone_number": "314-546-7517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7300 FOX CHASE DR",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633018360",
"telephone_number": "314-546-7517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RALPH",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-02",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2008022372",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2008022372",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.