Clark Johnson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8030412-2401 Issued in UT

Practice address

258 S Main St Ste 210
Logan, UT 84321-5768

Phone

(435) 383-6120

Fax

(435) 557-8003

NPI assigned

Dec 12, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlas Medical Utah LLCGroup PAC ID 4981937034, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Atlas Medical Utah LLC

  dba Sentry Medical

  • Internal Medicine Physician
  • Logan, UT
  • NPI 1568928133
  Medicare reassignment Care Compare group NPD
• RLC Physical Therapy & Rehab, LLC

  • Physical Therapist
  • Brigham City, UT
  • NPI 1801107495
  Medicare reassignment NPD
• KFDD Physical Therapy & Sports Medicine Clinic

  dba Sports Medicine Clinic

  • Physical Therapist
  • Ogden, UT
  • NPI 1013028505
  NPD (past)

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1407124910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 S MAIN ST STE 210",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215768",
            "telephone_number": "435-383-6120",
            "fax_number": "435-557-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 S MAIN ST STE 210",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215768",
            "telephone_number": "435-383-6120",
            "fax_number": "435-557-8003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "990 Medical Dr Ste U4",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843024714",
            "country_code": "US",
            "telephone_number": "435-383-6120",
            "fax_number": "435-557-8003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CLARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-12",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9307",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "38312",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "06226",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "19237",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "8030412-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Johansen
• Richard John, DO
• Bruce R. Johns, PHD
• Andrea Cara Johnson
• Aubrey Johnson, PMHNP-BC
• Corey B Johnson, MD
• Donna Johnson, ACMHC
• Kyle Cameron Johnson, DPT
• M. Andrew Johnson, DDS
• Marianne Johnson

• Physical Therapist in Logan, UT
• Providers in Logan, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.