Bethany Clark, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT28112 Issued in FL

Practice address

9 Pine Cone Dr Ste 104B
Palm Coast, FL 32137-8683

Phone

(386) 446-9716

NPI assigned

Feb 13, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1417296260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CAMDEN CAY DR",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320861814",
            "telephone_number": "440-864-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 PINE CONE DR STE 104B",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378683",
            "telephone_number": "386-446-9716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BETHANY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-13",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT28112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canice Chukwuocha, MD
• Michelle Lee Cinq-Mars
• Circle of Health Family Practice LLC
• Gregorio Alfonso Cisneros, MD
• Citrine Speech Therapy, LLC
• Cydney Clark
• Kaitlyn Maurene Clark, M.S CCC SLP
• Yolanda Clark, LPN
• Amanda Soto Clarke, RN
• Astrid Grace Clarke, MD

• Physical Therapist in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.