MEDICARE: DR. RICHARD C CLARK PT, DSCPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10879	TN

General Provider Information

NPI Number	:	1699744011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C CLARK PT, DSCPT

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DRIVE
Second Line	:	SUITE 600
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7286
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	4909 NOLENSVILLE RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-5411
Country	:	US
Telephone Number	:	615-333-9828
Fax Number	:	615-333-1176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/21/2022

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