Active NPI
Kyle Clark, DPT
- Sports Physical Therapist
- Alpharetta, GA
National Provider Identifier
1376170613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- Practice address
- 3155 N Point Pkwy
Alpharetta, GA 30005-5481 - Phone
- (815) 382-9497
- NPI assigned
- Mar 26, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | Primary |
Addresses
Primary practice location
3155 N Point Pkwy
Alpharetta, GA 30005-5481
Mailing address
3155 N Point Pkwy
Alpharetta, GA 30005-5481
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140547 | Other | CHILDREN'S HEALTHCARE OF ATLANTA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585180800000",
"number": "1376170613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3155 N POINT PKWY",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300055481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3155 N POINT PKWY",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300055481",
"telephone_number": "815-382-9497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KYLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-26",
"last_updated": "2020-03-26",
"certification_date": "2020-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDREN'S HEALTHCARE OF ATLANTA",
"identifier": "140547",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.