Kaitlyn Clark, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

41353 Issued in FL

Practice address

1994 State Road 44
New Smyrna Beach, FL 32168-8349

Phone

(386) 516-8344

NPI assigned

Mar 11, 2024

Sex

Female

Sole proprietor

No

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

Enrolled in MA, CA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bay State Physical Therapy of Randolph IncGroup PAC ID 6305744251, 451 clinicians

Burch Physical Therapy, Inc.Group PAC ID 2961438569, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bay State Physical Therapy of Randolph Inc

  • Physical Therapist
  • Fall River, MA
  • NPI 1164474334
  Medicare reassignment Care Compare group
• Burch Physical Therapy, Inc.

  • Physical Therapist
  • Redding, CA
  • NPI 1447215116
  Medicare reassignment Care Compare group
• Bay State Physical Therapy of Randolph Inc

  • Chiropractor
  • Quincy, MA
  • NPI 1316507627
  NPD
• Bay State Physical Therapy of Randolph Inc

  • Physical Therapist
  • Franklin, MA
  • NPI 1821108549
  NPD

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1972361376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1274 TUROCK DR",
            "city": "CUBA",
            "state": "NY",
            "postal_code": "147279452",
            "telephone_number": "716-244-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1994 STATE ROAD 44",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321688349",
            "telephone_number": "386-516-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KAITLYN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "051069",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "41353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clifford C. Chu, M.D.
• Church Parish Nurse Ministries
• Georgia Clanton
• Breon Clark
• Cadence Clark
• Sonya Miciak Clark, D.O.
• Tina Michelle Claybourn, LMT
• Lara L Clevenger, RD
• Mary Lou Clime
• Charles Trevon Clow, PH.D., LMHC

• Physical Therapist in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.