Russell Derrick Clark, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8087 Issued in SC

Practice address

1011 Grove Rd Ste 2a
Greenville, SC 29605-4660

Phone

(864) 233-5128

Fax

(864) 271-2599

NPI assigned

Mar 17, 2016

Sex

Male

Sole proprietor

No

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

Enrolled in NJ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fox Rehabilitation Services Inc

  • Physical Therapist
  • Wilmington, DE
  • NPI 1326092503

  NJ

  Medicare reassignment NPD
• At Home by Enhance Therapies LLC

  • Physical Therapist
  • Lakewood, NJ
  • NPI 1124603246
  NPD

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1639530686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 GROVE RD STE 2A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054660",
            "telephone_number": "864-233-5128",
            "fax_number": "864-271-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 GROVE RD STE 2A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054660",
            "telephone_number": "864-233-5128",
            "fax_number": "864-271-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RUSSELL",
        "middle_name": "DERRICK",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Bagwell Clark
• Madison Clark
• Martha Jameson Clark, APRN
• Mary Kathlyn Clark, FNP
• Matthew Thomas Clark, M.D.
• Sara Morgan Clark, M.D.
• Susan Nock Clark, RN
• Taylor Ellis Clark, FNP-C
• Thomas Monroe Clark, DDS
• William Leroy Clark, MD

• Physical Therapist in Greenville, SC
• Providers in Greenville, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.