Chandler Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2182964 Issued in TX

Practice address

3100 Olympus Blvd Ste 500
Coppell, TX 75019-5473

Phone

(214) 442-4329

NPI assigned

Sep 18, 2024

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": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1619704178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 HOLLYTREE DR APT 3002",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033486",
            "telephone_number": "903-520-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OLYMPUS BLVD STE 500",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750195473",
            "telephone_number": "214-442-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHANDLER",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2182964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry Chu, PT, DPT
• Bora Chung
• Nancy Meongju Chung, M.D.
• Olivia R Ciraulo
• City of Coppell Fire Department
• Joshua Maxson Clark, MD
• Kelsey Anne Clark
• Nathan Clark
• Clear Vision Associates PLLC
• Clinical Neurosciences, PLLC

• Physical Therapy Assistant in Coppell, TX
• Providers in Coppell, 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, 2024; 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.