Stephen B Clark, DPT, MS, ATC, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL20174 Issued in MA

Practice address

369 Huntington Ave
Boston, MA 02115-4402

Phone

(617) 399-7330

Fax

(617) 399-7331

NPI assigned

Jul 10, 2012

Last updated

Feb 6, 2024By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1396000998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 JOHN CARVER RD",
            "city": "READING",
            "state": "MA",
            "postal_code": "018672028",
            "telephone_number": "617-610-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 HUNTINGTON AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021154402",
            "telephone_number": "617-399-7330",
            "fax_number": "617-399-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DPT, MS, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "AT1646",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "PTL20174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monina Topacio Clark, CRNA
• Nisse Virginia Clark, M.D.
• Oliver Copp Clark, MB BCH BAO
• Roger P. Clark, D.O.
• Samantha Clark
• Timothy Walter Seth Clark, M.D.
• Asha L Clarke, MD
• Giselle Clarke
• Hillary Ann Clarke, PA-C
• Katherine Clarke, LCSW

• Physical Therapist in Boston, MA
• Providers in Boston, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.