Carla Marie Clark, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

AT 6660 Issued in CA

Practice address

709 W Channel Islands Blvd
Suite 157
Port Hueneme, CA 93041-2130

Phone

(805) 382-6245

Fax

(805) 382-6245

NPI assigned

Sep 19, 2007

Last updated

Sep 19, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Carla Marie Clark Other name

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": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1982890414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W CHANNEL ISLANDS BLVD",
            "address_2": "SUITE 157",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412130",
            "telephone_number": "805-382-6245",
            "fax_number": "805-382-6245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 W CHANNEL ISLANDS BLVD",
            "address_2": "SUITE 157",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412130",
            "telephone_number": "805-382-6245",
            "fax_number": "805-382-6245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARLA",
        "middle_name": "MARIE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-19",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "AT 6660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLA",
            "last_name": "CLARK",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "PTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ted Jamir Camaisa, D.D.S.
• Eric Lance Campbell
• Kimberly Castillo, OD
• Dianna Castro
• Esther Chan, PHARMD
• Steven Daniel Clement, DO
• Lashay C Clemons, REGISTERED NURSE
• Coastal Health Laser Aesthetics (A Nu Me)
• Mike Cockrill, IDC
• Thomas A Colp, OD

• Physical Therapy Assistant in Port Hueneme, CA
• Providers in Port Hueneme, 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 Sep 19, 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.