Active NPI
Kaarin Marissa Clark, PT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1528629219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT295451
- Practice address
- 2145 Ebers St
San Diego, CA 92107-2241 - Phone
- (619) 504-4527
- NPI assigned
- Jun 24, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT295451 | CA | Primary |
Addresses
Primary practice location
2145 Ebers St
San Diego, CA 92107-2241
Mailing address
2145 Ebers St
San Diego, CA 92107-2241
Phone (619) 504-4527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT295451 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RL Speech Therapy, Apc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561334400000",
"number": "1528629219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2145 EBERS ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921072241",
"telephone_number": "619-504-4527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2145 EBERS ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921072241",
"telephone_number": "619-504-4527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KAARIN",
"middle_name": "MARISSA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-24",
"last_updated": "2019-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT295451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.