Healthcare Provider Details

I. General information

NPI: 1811801830
Provider Name (Legal Business Name): ASHLEY MICHELLE CLARK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 MONROVIA ST
LENEXA KS
66215-3537
US

IV. Provider business mailing address

14113 FONTANA ST
LEAWOOD KS
66224-1156
US

V. Phone/Fax

Practice location:
  • Phone: 573-641-8328
  • Fax:
Mailing address:
  • Phone: 913-200-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-08253
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: