Wesley Ethan Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1142982 Issued in TX

Practice address

931 York Dr
Suite a
Desoto, TX 75115-2043

Phone

(972) 296-6645

Fax

(972) 296-4526

NPI assigned

Jul 3, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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)

Enrolled

Practice roles

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.

• Crossroads Physical Therapy Limited Partnership

  dba Green Oaks PT - Ft. Worth

  • Physical Therapist
  • Fort Worth, TX
  • NPI 1124065578
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730118381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 YORK DR",
            "address_2": "SUITE A",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152043",
            "telephone_number": "972-296-6645",
            "fax_number": "972-296-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 YORK DR",
            "address_2": "SUITE A",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152043",
            "telephone_number": "972-296-6645",
            "fax_number": "972-296-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WESLEY",
        "middle_name": "ETHAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1142982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann Christle, NRCMA, AA HEALTHCARE
• Eke Egbuta Chukwu
• Circle of Healing Chiropractic
• City of Desoto (DeSoto Fire Rescue)
• Brianna Clark
• Eileen Cilia Clavijo
• Clinical Healthcare Consultants
• Cnbfac Creating New Beginning for All Children
• Theresa Cobbins
• Cohealth Psychology Services, P.a.

• Physical Therapist in Desoto, TX
• Providers in Desoto, TX by specialty
• Physical Therapist in Texas

• 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.

Verify at the official NPI Registry.