Rachel Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A2558 Issued in MN

Practice address

11800 Xeon Blvd NW
Coon Rapids, MN 55448-2061

Phone

(763) 755-8400

NPI assigned

Jan 19, 2022

Last updated

Jan 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

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": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1891447165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 XEON BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482061",
            "telephone_number": "763-755-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 XEON BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482061",
            "telephone_number": "763-755-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RACHEL",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "A2558",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A2558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Christy, NP
• Grace Chun, MD
• Grace Anne Cimino, M.S.
• Gregory Alexander Clark, O.D.
• Misty Lee Clark
• CLD - Coon Rapids MN, LLC
• Jay Robert Clemens, LADC
• Jenna Michele Clements, PA
• Dean J Cochrane, CRNA
• Lisa Y Cole, CRNA

• Physical Therapy Assistant in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.