Stephen Clark

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1502 Issued in NM

Practice address

1400 Main St NW Ste 1&2
Los Lunas, NM 87031-4812

Phone

(505) 865-4368

NPI assigned

Jan 3, 2023

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

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 and National Provider Directory roles.

• Armada Physical Therapy of Albuquerque LLC

  dba Armada Physical Therapy

  • Multi-Specialty Clinic/Center
  • Albuquerque, NM
  • NPI 1851713663
  NPD

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1689387805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 CABEZON BLVD SE STE 102",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST NW STE 1&2",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870314812",
            "telephone_number": "505-865-4368"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 Cabezon Blvd SE Ste 102",
            "address_purpose": "LOCATION",
            "city": "Rio Rancho",
            "state": "NM",
            "postal_code": "871241513",
            "country_code": "US",
            "telephone_number": "505-994-2599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": "PTA1502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Leander Cheshire III, PH.D.
• Danayara Childress, RN
• Crystal Chilton
• Lorinda Clark
• Shelley Clark
• Verena Clark
• Waylon Clark
• Luz Clouser
• Joyce Collins
• Alyssa Estrella Rose Contreras

• Physical Therapy Assistant in Los Lunas, NM
• Providers in Los Lunas, NM by specialty
• Physical Therapy Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.