Gabriella Gonzalez Clark, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT35605 Issued in FL

Practice address

11140 SW 88TH St Ste 200
Miami, FL 33176-0901

Phone

(305) 271-3223

NPI assigned

Mar 13, 2020

Last updated

Nov 25, 2022By 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

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Florida Luna Care Physical Therapy LLC

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1114542032
  Medicare reassignment NPD

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669334400000",
    "number": "1932735743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21483 SW 132ND PL",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331776249",
            "telephone_number": "786-200-3084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11140 SW 88TH ST STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331760901",
            "telephone_number": "305-271-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GABRIELLA",
        "middle_name": "GONZALEZ",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-13",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT35605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ambur Clark
• Carol L Clark, LMHC
• Craig Alan Clark, M.S., R.D.
• Curtis Robert Clark, P.T.
• Dwight Lamont Clark
• John Elbert Clark, PHARMD
• Lian-Kim Clark
• Michael Joseph Clark
• Tahnee Morgan Clark, APRN
• Theodore Ronald Clark Jr.

• Physical Therapist in Miami, FL
• Providers in Miami, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.