Delane F Clark, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2756 Issued in NC

Practice address

328 Whippoorwill LN
Mt Holly, NC 28120-9765

Phone

(704) 827-3788

Fax

(704) 827-3799

NPI assigned

Aug 8, 2006

Last updated

Apr 10, 2012By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Shining Hope Farms

  • Occupational Therapist
  • Mount Holly, NC
  • NPI 1144369224

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1740290303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 BETH HAVEN CHURCH RD",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280378124",
            "telephone_number": "704-736-0996",
            "fax_number": "704-736-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 WHIPPOORWILL LN",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281209765",
            "telephone_number": "704-827-3788",
            "fax_number": "704-827-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DELANE",
        "middle_name": "F",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "2756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7212080",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.