Jeffrey Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2004982 Issued in TX

Practice address

1010 W Main St
Henderson, TX 75652-2923

Phone

(903) 657-6945

Fax

(903) 657-9061

NPI assigned

Sep 18, 2007

Last updated

Sep 18, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190073600000",
    "number": "1467648048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 KELLI DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751269564",
            "telephone_number": "972-552-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W MAIN ST",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756522923",
            "telephone_number": "903-657-6945",
            "fax_number": "903-657-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JEFFREY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2004982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph G. Carver, D.O.
• Kimberly Catlin, N.P.,
• Tommy Chambers, LPC-S
• Epiniah Shamiso Choga, MD
• John Rogers Clague, M.D.
• Kristal Clay
• Clinical Partners Henderson
• Crystal Cloutier, COTA
• Tina L Coen
• Michael Craig Colotta, FNP-C

• Physical Therapy Assistant in Henderson, TX
• Providers in Henderson, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; 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.