Kelly L Clark in Conway - Physical Therapy Assistant
Kelly L Clark - NPI 1053417907
Kelly L Clark is a Physical Therapy Assistant in Conway, Arkansas. Kelly L Clark practices all healthcare services and medical treatments related to Physical Therapy Assistant. The NPI Number for Kelly L Clark is 1053417907. The last update date is 2007-07-08.
Kelly L Clark's current location address is 1500 Museum Rd Ste 104, Conway, Arkansas. You can contact this provider via phone number 5013293804 and fax number 5013290718. The mailing address for Kelly L Clark is 1500 Museum Rd Ste 104, Conway, Arkansas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kelly L Clark |
|---|---|
| Address | 1500 Museum Rd Ste 104, Conway, Arkansas |
| Phone Number | 5013293804 |
| Fax Number | 5013290718 |
| Sole Proprietor | Y |
| Credentials | PTA |
NPI Number Detail
| NPI Number | 1053417907 |
|---|---|
| Provider Enumeration Date | 2006-09-16 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 1500 Museum Rd Ste 104 |
|---|---|
| City | Conway |
| State | Arkansas (AR) |
| Post Code | 720324761 |
| Phone Number | 5013293804 |
| Fax Number | 5013290718 |
Provider's Primary Taxonomy Detail
| Speciality | Physical Therapy Assistant |
|---|---|
| Taxonomy | 225200000X |
| Licence No | 2010 |
|
Definition: (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Post |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 2010 | AR | PTA LICENSE |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Kelly L Clark by the Centers for Medicare & Medicaid Services?
The Kelly L Clark has been issued the NPI (National Provider Identifier) 1053417907, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Kelly L Clark is physically located?
The Kelly L Clark is physically situated at the following address: 1500 Museum Rd Ste 104, Conway, AR, 720324761.
What is Kelly L Clark's specialized field of practice, and what is the corresponding taxonomy classification code?
The Kelly L Clark's area of specialization is Physical Therapy Assistant, and the corresponding taxonomy code that categorizes this field of practice is 225200000X.
On what date did the Kelly L Clark receive the assignment of its 1053417907 from the Centers for Medicare & Medicaid Services?
The Kelly L Clark was issued its 1053417907 by the Centers for Medicare & Medicaid Services on 2006-09-16.
As of what date were the details pertaining to Kelly L Clark last refreshed?
The information related to the Kelly L Clark, including its address, specialty, and other relevant details, was last updated on 2007-07-08.