Michelle Renee Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT14472 Issued in CA

Practice address

25285 Madison Ave
Suite 104
Murrieta, CA 92562-8955

Phone

(951) 600-2990

Fax

(951) 600-7224

NPI assigned

Dec 12, 2005

Sex

Female

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 CA

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.

• The Rehab Group

  • Physical Therapist
  • Murrieta, CA
  • NPI 1912118076
  Medicare reassignment NPD
• U S Healthworks Medical Group

  • Physical Therapist
  • Murrieta, CA
  • NPI 1134361264
  NPD (past)
• West Star Physical Therapy, Inc.

  • Physical Therapist
  • Garden Grove, CA
  • NPI 1376764571
  NPD (past)

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

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601164800000",
    "number": "1699750778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40680 CALIFORNIA OAKS RD",
            "address_2": "STE 2A",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925625755",
            "telephone_number": "951-894-4800",
            "fax_number": "951-894-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25285 MADISON AVE",
            "address_2": "SUITE 104",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925628955",
            "telephone_number": "951-600-2990",
            "fax_number": "951-600-7224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-12",
        "last_updated": "2020-09-27",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Senga Clamor, LAC
• Irelyn Nichole Clapp
• Brianna Lindsey Clark
• Juanette G Clark, FNP
• Livier Clark
• Paul Clark
• Clarke Psychotherapy Inc
• Nishana R Clarke, M.S., MFT
• Clearpath Kidney Dietetics
• Soraya Cleary

• Physical Therapist in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2020; 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.