Active NPI
Jon Allen Clark, PT
- Physical Therapist
- Dallas, TX
National Provider Identifier
1699983445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1135218
- Practice address
- 2535 Lone Star Dr
Dallas, TX 75212-6313 - Phone
- (214) 467-9787
- NPI assigned
- May 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1135218 | TX | Primary |
Addresses
Primary practice location
2535 Lone Star Dr
Dallas, TX 75212-6313
Mailing address
613 Catalpa Rd
Fort Worth, TX 76131-3537
Phone (682) 286-9449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1135218 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699983445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 CATALPA RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761313537",
"telephone_number": "682-286-9449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2535 LONE STAR DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752126313",
"telephone_number": "214-467-9787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JON",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1135218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.