Clark Kevin Cole, PHYSICAL THERAPTIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1078459 Issued in TX

Practice address

1005 NE Big Bend TRL
Suite 3
Glen Rose, TX 76043-4942

Phone

(254) 898-2121

Fax

(254) 898-1616

NPI assigned

Aug 19, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Glen Rose Physical Therapy and Sports Rehab, P.C.

  • Physical Therapist
  • Glen Rose, TX
  • NPI 1639228844
  NPD (past) Authorized official
• Granbury Hospital Corporation

  • Medicare Defined Swing Bed Hospital Unit
  • Granbury, TX
  • NPI 1265403778
  NPD (past)

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972617306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760430292",
            "telephone_number": "254-898-2121",
            "fax_number": "254-898-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 NE BIG BEND TRL",
            "address_2": "SUITE 3",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760434942",
            "telephone_number": "254-898-2121",
            "fax_number": "254-898-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "CLARK",
        "middle_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1078459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Denise Champion
• Charis Psychological Services & Christian Counseling, PLLC
• Cherokee Rose Nursing and Rehabilitation LP
• Jason Clevenger
• Jon Jason Coble, D.C.
• County of Somervell
• Kevin Andrew Crawford, CRNA
• Teresa Collier Crosby, FNP-BC
• Jennifer Joella Cullen, D.C.
• D. Barnes, Crna,PC

• Physical Therapist in Glen Rose, TX
• Providers in Glen Rose, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.