Active NPI
Brett Benjamin Clark, PT
- Physical Therapist
- Towson, MD
National Provider Identifier
1740233535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17644
- Practice address
- 110 West Rd
Suite 105
Towson, MD 21204-2316 - Phone
- (410) 321-4901
- NPI assigned
- May 19, 2006
- 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 | 17644 | MD | Primary |
Addresses
Primary practice location
110 West Rd
Suite 105
Towson, MD 21204-2316
Mailing address
110 West Rd
Suite 105
Towson, MD 21204-2316
Phone (410) 321-4901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- University of Maryland School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
650 McHenry Rd
Suite 1100
Aberdeen, MD 21001-2607
Phone (443) 843-8702
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smith & Prothero Physical Therapy LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194307200000",
"number": "1740233535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WEST RD",
"address_2": "SUITE 105",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042316",
"telephone_number": "410-321-4901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WEST RD",
"address_2": "SUITE 105",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042316",
"telephone_number": "410-321-4901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRETT",
"middle_name": "BENJAMIN",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2007-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "17644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Towson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; 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.