Active NPI
Robert L. Clark, PT
- Physical Therapist
- Petaluma, CA
National Provider Identifier
1376627885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P.T. 10768
- Practice address
- 169 Lynch Creek Way
Petaluma, CA 94954-2344 - Phone
- (707) 763-0115
- Fax
- (707) 763-2130
- NPI assigned
- Oct 24, 2006
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P.T. 10768 | CA | Primary |
Addresses
Primary practice location
169 Lynch Creek Way
Petaluma, CA 94954-2344
Mailing address
538 Acadia Dr
Petaluma, CA 94954-6681
Phone (707) 778-2388
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P.T. 10768 | CA | MD | Physical Therapist |
| 10768 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376627885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "538 ACADIA DR",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949546681",
"telephone_number": "707-778-2388",
"fax_number": "707-763-2130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 LYNCH CREEK WAY",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949542344",
"telephone_number": "707-763-0115",
"fax_number": "707-763-2130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ROBERT",
"middle_name": "L.",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "P.T. 10768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.