Active NPI
James Marion Clark, PTA
- Physical Therapy Assistant
- West Columbia, SC
National Provider Identifier
1407093149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1633
- Practice address
- 2318 Sunset Blvd
West Columbia, SC 29169-4716 - Phone
- (803) 454-6090
- NPI assigned
- Jan 16, 2009
- 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 Therapy Assistant | 225200000X | 1633 | SC | Primary |
Addresses
Primary practice location
2318 Sunset Blvd
West Columbia, SC 29169-4716
Mailing address
1053 Center St
West Columbia, SC 29169-6749
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 |
|---|---|---|---|
| 1633 | SC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232064000000",
"number": "1407093149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1053 CENTER ST",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291696749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2318 SUNSET BLVD",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291694716",
"telephone_number": "803-454-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JAMES",
"middle_name": "MARION",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-16",
"last_updated": "2009-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SC",
"license": "1633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.