Ashley E Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12733 Issued in NC

Practice address

3463 Highway 21 Ste 112
Fort Mill, SC 29715-7210

Phone

(704) 900-3674

NPI assigned

Aug 9, 2010

Last updated

Feb 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revive Neurorecovery Center CLT LLC

  • Physical Therapist
  • Fort Mill, SC
  • NPI 1679201123
  NPD Authorized official

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1669787107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 STE 112",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157210",
            "telephone_number": "704-900-3674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 STE 112",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157210",
            "telephone_number": "704-900-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ASHLEY",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "11423",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "12733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin Peter Cichon, MD
• Circle of Care Healthcare Agency
• Nicole Clamp, APRN
• Claridge Behavioral Consulting, LLC
• Clark and Jackson PD, LLC
• Katherine Elizabeth Clark, DMD
• Nicola Marie Clarke, NP
• Stephanie Marie Clemente, BCBA
• Close to Home Teen & Family SVCS
• CMP Senior Healthcare LLC

• Physical Therapist in Fort Mill, SC
• Providers in Fort Mill, 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 Feb 25, 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.