Nathan Clark

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9613 Issued in SC

Practice address

3100 Olympus Blvd Ste 500
Coppell, TX 75019-5473

Phone

(866) 221-5405

NPI assigned

Apr 29, 2019

Last updated

Apr 29, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Parish Therapy Center, LLCGroup PAC ID 8022048867, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Jackson Parish Therapy Center LLC

  dba Fyzical Therapy & Balance Centers

  • Physical Therapist
  • Ruston, LA
  • NPI 1891794491
  Medicare reassignment Care Compare group NPD
• Therateam Outpatient Services, LLC

  • Orthopedic Physical Therapist
  • Haughton, LA
  • NPI 1821333055
  Medicare reassignment NPD
• Jesse L Wied PT Physical Therapy Clinic Inc

  dba Wied Physical Therapy

  • Physical Therapist
  • Monroe, LA
  • NPI 1538101902
  NPD (past)

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1932763570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 STOW CREEK RD",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712701643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OLYMPUS BLVD STE 500",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750195473",
            "telephone_number": "866-221-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NATHAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "9613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia R Ciraulo
• City of Coppell Fire Department
• Chandler Clark, PTA
• Joshua Maxson Clark, MD
• Kelsey Anne Clark
• Clear Vision Associates PLLC
• Clinical Neurosciences, PLLC
• Coe Dentistry PLLC
• Karen Ardila Coe, D.D.S.
• Kariane Coffield, OTR

• Physical Therapist in Coppell, TX
• Providers in Coppell, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.