Shawna David Clack, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT012897 Issued in GA

Practice address

60 Exchange St Ste B4
Richmond Hill, GA 31324-7646

Phone

(912) 459-0072

Fax

(912) 459-0511

NPI assigned

Jun 8, 2017

Last updated

Jun 8, 2017By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bluffton Mobile Physical TherapyGroup PAC ID 7315344595, 6 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bluffton Mobile Physical Therapy

  • Physical Therapist
  • Bluffton, SC
  • NPI 1962170753
  Medicare reassignment Care Compare group NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  Medicare reassignment NPD
• Independent Physical Therapy of Georgia, LLC

  dba BenchMark Physical Therapy

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment NPD
• Optim Orthopedics, LLC

  dba Optim Orthopedics

  • Orthopaedic Surgery Physician
  • Savannah, GA
  • NPI 1780077982
  Medicare reassignment NPD
• Optim Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Bluffton, SC
  • NPI 1528451481
  Medicare reassignment NPD
• Atlanta South Physical Therapy, Inc

  dba Rehab South

  • Physical Therapist
  • Lawrenceville, GA
  • NPI 1922051564
  NPD
• Independent Physical Therapy of Georgia, LLC

  dba Benchmark PT

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD
• Optim Orthopedics, LLC

  dba Optim Orthopedics

  • Orthopaedic Surgery Physician
  • Jesup, GA
  • NPI 1467845404
  NPD
• Optim Orthopedics, LLC

  dba Optim Orthopedics

  • Orthopaedic Surgery Physician
  • Midway, GA
  • NPI 1821639758
  NPD (past)

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1710416185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212564",
            "telephone_number": "423-238-7217",
            "fax_number": "423-362-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 EXCHANGE ST STE B4",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313247646",
            "telephone_number": "912-459-0072",
            "fax_number": "912-459-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "SHAWNA",
        "middle_name": "DAVID",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT012897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Javoris Chatman, RBT
• Sharonda Lacretia Carol Cheever, DDS
• Choice Care Medical
• Carey Lee Christiansen Ford, MD
• Christopher a. Kuettner, MD
• Melody Faith Clark
• Riley Ann Clay
• Jennifer Jean Clements, M.D.
• Kinsley M Clements, RBT
• Coastal Chiropractic and Family Wellness

• Physical Therapist in Richmond Hill, GA
• Providers in Richmond Hill, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.