Theron A Clarke

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

0274631 Issued in NY

Practice address

13327 231St St
Laurelton, NY 11413-2121

Phone

(646) 725-9403

NPI assigned

Dec 6, 2021

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1609534718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13327 231ST ST",
            "city": "LAURELTON",
            "state": "NY",
            "postal_code": "114132121",
            "telephone_number": "646-725-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13327 231ST ST",
            "city": "LAURELTON",
            "state": "NY",
            "postal_code": "114132121",
            "telephone_number": "646-725-9403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13327 231st St",
            "address_purpose": "LOCATION",
            "city": "Laurelton",
            "state": "NY",
            "postal_code": "114132121",
            "country_code": "US",
            "telephone_number": "646-725-9403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "THERON",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "0274631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Angela Christian
• Kashara Ashara Christie-Cuascut, RN
• Kasiemobi Chukwuka, LPN
• Kerlande Ciceron, RN
• Andrea Clarke
• Philip W. Clifton, DDS
• CMC Mental Health Consulting Services
• Caroline Cobblah, NP
• Patricia Codrington
• Bernard Colclough, LPN

• Massage Therapist in Laurelton, NY
• Providers in Laurelton, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.