Active NPI
Clarence Ryan Brackett, MPT
- Physical Therapist
- Spartanburg, SC
National Provider Identifier
1700042348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3997
- Practice address
- 1330 Boiling Springs Rd
Suite 1600B
Spartanburg, SC 29303-4201 - Phone
- (864) 582-0019
- NPI assigned
- Aug 4, 2008
- 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 | 3997 | SC | Primary |
Addresses
Primary practice location
1330 Boiling Springs Rd
Suite 1600B
Spartanburg, SC 29303-4201
Mailing address
1330 Boiling Springs Rd
Suite 1600B
Spartanburg, SC 29303-4201
Phone (864) 582-0019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3997 | Other | SC | STATE LICENSE NUMBER |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217808000000",
"number": "1700042348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1330 BOILING SPRINGS RD",
"address_2": "SUITE 1600B",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293034201",
"telephone_number": "864-582-0019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 BOILING SPRINGS RD",
"address_2": "SUITE 1600B",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293034201",
"telephone_number": "864-582-0019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKETT",
"first_name": "CLARENCE",
"middle_name": "RYAN",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-04",
"last_updated": "2008-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "3997",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "3997",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.