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General NPI Number Information
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NPI Number | 1013950211
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Entity Type | Individual
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Provider Name | CLARK E. SIMPSON LAT/ATC
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3831 E. 400 SOUTH
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City | MIDDLETOWN
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State | IN
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Zip | 47356
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Country | US
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Telephone | 765-779-0004
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Fax | 765-779-0005
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Provider Business Mailing Address
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Address Line | 3831 E. 400 SOUTH
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City | MIDDLETOWN
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State | IN
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Zip | 47356
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Country | US
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Telephone | 765-779-0004
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Fax | 765-779-0005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36000195
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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