Erica Lynne Clark, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Mercer Island, WA
NPI 1407830359 · NPPES record last updated Jul 26, 2022
Key facts
- NPI
- 1407830359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT00006742 (WA)
- Practice address
- 9311 SE 36TH St Ste 208
Mercer Island, WA 98040-3741 - Phone
- (206) 402-6339
- Fax
- (206) 456-2551
- NPI assigned
- Dec 5, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bridge Physical Therapy and Wellness
Practice addresses (Care Compare)
7750 80TH PL SE
Mercer Island, WA 98040-5912
Phone (206) 818-9425
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040903000683 | WA | Practitioner - Physical Therapist in Private Practice | 4082680715 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridge Physical Therapy and Wellness | Physical Therapist | Current |
Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Locations
9311 SE 36th St
Ste 208
Mercer Island, WA 98040
Phone (206) 402-6339
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00006742 | WA | Yes |
Addresses
Primary practice location
9311 SE 36TH St Ste 208
Mercer Island, WA 98040-3741
Mailing address
7228 W Mercer Way
Mercer Island, WA 98040-5572
Phone (206) 954-6936
Other practice location 1
4701 41st Ave SW
Ste 100
Seattle, WA 98116-4597
Phone (206) 932-8363
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7046626 | Medicaid | WA |
Other providers in Mercer Island, WA
- Jamie Samra Cho
- Nakyung Choe
- Samuel Chong
- City of Mercer Island
- City of Mercer Island
- Tumaini Rucker Coker
- Paul Dewitt Conrad
- Cormedical, Inc.
- Jillian Clarke Correa
- Covenant Living West
All providers in Mercer Island, WA · Physical Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.