Gwendolyn Clarke, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

50045 Issued in CA

Practice address

590 S Magnolia Ave
El Cajon, CA 92020-6011

Phone

(619) 444-6113

NPI assigned

Jul 29, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1982258810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6780 FRIARS RD UNIT 117",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081184",
            "telephone_number": "720-244-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S MAGNOLIA AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920206011",
            "telephone_number": "619-444-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "GWENDOLYN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-29",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "50045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steffany Clancy
• Moriah Clark-Dismuke
• Dyana Clark, MA, LPC
• Nechole Clark
• Tytianna Monika Clark
• Colin David Clay
• John Clayborne
• Claydelle Healthcare LLC
• Jacelin Clayton
• Jarrett Jemale Clifton, LEP

• Physical Therapy Assistant in El Cajon, CA
• Providers in El Cajon, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2019; 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.