Provider Demographics
NPI:1447685516
Name:CLARKE, DAVID (DPT, PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:75 FINNELL DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188
Practice Address - Country:US
Practice Address - Phone:781-335-1151
Practice Address - Fax:781-335-7851
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4741862OtherAETNA
MA051668OtherUNITED HEALTHCARE/OPTUM
MA110101073AMedicaid
MA1269242OtherCIGNA/ASH