Mark Allen Clark, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Lagrange, KY
NPI 1912929720 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1912929720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 001751 (KY)
- Practice address
- 5201 Arrowshire Dr
Lagrange, KY 40031-9600 - Phone
- (502) 222-2615
- Fax
- (502) 222-2617
- NPI assigned
- Jul 24, 2006
- Reactivated
- May 31, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001751 | KY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| At Home Rehab Alliance, Inc | Physical Therapist | Past |
Accepting new patients |
| Simetria Fall Prevention Centers LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 001751 | KY | Yes |
Addresses
Primary practice location
5201 Arrowshire Dr
Lagrange, KY 40031-9600
Mailing address
5201 Arrowshire Dr
Lagrange, KY 40031-9600
Phone (502) 222-2615
Other providers in Lagrange, KY
- Cathy M Borders
- Karen Butterfield
- Steven Michael Byrne
- Zachary Byrne
- Cardiac Care Center of Louisville, PLLC
- Lisa Conti
- Janet L Cox
- Shannon Michelle Coyle
- Kamlesh C Dave
- Kelly Jean Dike
All providers in Lagrange, KY · Physical Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.