Justin Thomas Clark, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P21047 Issued in NC

Practice address

7300 S Raeford Rd
Fayetteville, NC 28304-6162

Phone

(910) 908-2222

NPI assigned

Mar 30, 2022

Last updated

Mar 30, 2022By 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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1871233700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 S RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283046162",
            "telephone_number": "910-908-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 S RAEFORD RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283046162",
            "telephone_number": "910-908-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUSTIN",
        "middle_name": "THOMAS",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P21047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS",
            "identifier": "P21047",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "justin.clark3@va.gov",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7300 S Raeford Rd",
            "city": "Fayetteville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283046162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Denaziah Clark
• Edward G Clark
• Erin Olivia Clark
• James Clark
• Jennifer Lynn Clark, PHARMD
• Kelsey Bernice Clark, FNP-C
• Kelvin D Clark, MS, LMFT, LPC, LCAS
• Lamar Wayne Clark, CRNA
• Louis Phillip Clark Jr., M.D.
• Ralph O Clark, LMFT, LPCA

• Physical Therapist in Fayetteville, NC
• Providers in Fayetteville, 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 Mar 30, 2022; 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.