Active NPI
Vicki Clark, P.T.
- Specialist
- Bethel, CT
National Provider Identifier
1972990349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 004289
- Practice address
- 13 Park Lawn Dr
Bethel, CT 06801-1043 - Phone
- (203) 830-4180
- NPI assigned
- Apr 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 004289 | CT | Primary |
Addresses
Primary practice location
13 Park Lawn Dr
Bethel, CT 06801-1043
Mailing address
68 Mile Hill Rd S
Newtown, CT 06470-2360
Phone (203) 426-6001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013083 | CT | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429747200000",
"number": "1972990349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 MILE HILL RD S",
"city": "NEWTOWN",
"state": "CT",
"postal_code": "064702360",
"telephone_number": "203-426-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 PARK LAWN DR",
"city": "BETHEL",
"state": "CT",
"postal_code": "068011043",
"telephone_number": "203-830-4180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "VICKI",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-23",
"last_updated": "2015-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CT",
"license": "004289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethel, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.