Joan M Clark, PT
Individual provider Active NPI Physical Therapist · Palmyra, VA
NPI 1790786176 · NPPES record last updated Nov 7, 2012
Key facts
- NPI
- 1790786176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2305004236 (VA)
- Practice address
- 285 Jefferson Dr W
Palmyra, VA 22963-2404 - Phone
- (434) 589-8865
- Fax
- (434) 589-8865
- NPI assigned
- Aug 9, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
Palmyra, VA 22963
Phone (434) 962-2803
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050301000166 | VA | Practitioner - Physical Therapist in Private Practice | 0042263162 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305004236 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bodyworks Physical Therapy and Wellness LLC | Physical Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305004236 | VA | Yes |
Addresses
Primary practice location
285 Jefferson Dr W
Palmyra, VA 22963-2404
Mailing address
285 Jefferson Dr W
Palmyra, VA 22963-2404
Phone (434) 589-8865
Other names
- Miss Joan M Clark
Other providers in Palmyra, VA
- Kelly Lynn Caniglia
- Carmelo F Caratozzolo
- Allyson Carter
- Brett L. Castrodale
- Sandra Mae Chirico
- Justin Andrew Coles
- Commonwealth of Virginia State Board of Health
- Alexa Cservek
- Valerie D Cunningham
- Elizabeth Daidone
All providers in Palmyra, VA · Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.