Stephen Thomas Clark, PT, DPT, ATC, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT011085 Issued in GA

Practice address

1025 Highway 34 E
Newnan, GA 30265-6803

Phone

(770) 290-8002

NPI assigned

Aug 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Texas Physical Therapy Specialists

  • Physical Therapy Clinic/Center
  • Austin, TX
  • NPI 1538246798

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1508298522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 HIGHWAY 34 E",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656803",
            "telephone_number": "770-290-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 HIGHWAY 34 E",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656803",
            "telephone_number": "770-290-8002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3052 Bardstown Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402053020",
            "country_code": "US",
            "telephone_number": "502-454-5544",
            "fax_number": "502-454-5562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "middle_name": "THOMAS",
        "credential": "PT, DPT, ATC, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "CP008179T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1244088",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT011085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Newnan",
            "affiliation": "N",
            "address_1": "1025 Highway 34 E",
            "city": "Newnan",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302656803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daijah Breaunna Clark
• Janea' Clark, CCC-SLP
• Kathy Clark, M.A., NCC, LPC
• Monica Clark
• Morgan Alexis Clark
• Yanett Paz Clark
• Lashante Clarke
• Clear Vision Optical Inc
• Kevin T. Cleary, M.D.
• Cleland Periodontics, PC

• Physical Therapist in Newnan, GA
• Providers in Newnan, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; 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.