Melissa Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1116291 Issued in TX

Practice address

910 E Southlake Blvd Ste 155
Southlake, TX 76092-6389

Phone

(817) 421-5000

Fax

(972) 506-8733

NPI assigned

Nov 22, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

86.09 of 100Reported as group

Quality

74.72

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: melissa.clark.1@15749.direct.athenahealth.com

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

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1609585256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W LBJ FWY STE 330",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750633717",
            "telephone_number": "972-556-2885",
            "fax_number": "972-506-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 E SOUTHLAKE BLVD STE 155",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926389",
            "telephone_number": "817-421-5000",
            "fax_number": "972-506-8733"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7501 Las Colinas Blvd Ste 125",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750637004",
            "country_code": "US",
            "telephone_number": "972-556-2885 x1701",
            "fax_number": "972-506-8733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 W Lbj Fwy Ste 330",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750633717",
            "country_code": "US",
            "telephone_number": "972-556-2885 x1601",
            "fax_number": "972-506-8733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MELISSA",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-22",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1116291",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1116291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci M Cihon, PHD, BCBA-D
• Cim Medical,PLLC
• City of Southlake Tex
• Anna L Clark
• Cameron Whitaker Clark, P.A.
• Olivia Clark, DPT
• Randall Edward Clark Jr.
• David Clay IV, DPT
• Clearview Surgery Center Inc
• Clifton L. Cox II M D P a

• Physical Therapist in Southlake, TX
• Providers in Southlake, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.