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General NPI Number Information
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NPI Number | 1609005107
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Entity Type | Individual
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Provider Name | JAMES BUTCH CLARK PT
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Gender | Male
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1050 OLD CAMP RD SUITE 282
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City | THE VILLAGES
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State | FL
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Zip | 32162
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Country | US
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Telephone | 417-576-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 11962 COUNTY RD 101 SUITE 104
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City | THE VILLAGES
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State | FL
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Zip | 32162
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Country | US
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Telephone | 352-254-3368
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3159
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 38587
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License Number State | FL
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