Provider Demographics
NPI:1609891183
Name:CLARKE, JAMES R (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 PARKLAWN DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2529
Mailing Address - Country:US
Mailing Address - Phone:301-770-3133
Mailing Address - Fax:301-770-3015
Practice Address - Street 1:11820 PARKLAWN DR
Practice Address - Street 2:SUITE 180
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2529
Practice Address - Country:US
Practice Address - Phone:301-770-3133
Practice Address - Fax:301-770-3015
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000N83M28Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
MPG00328Medicare ID - Type UnspecifiedMEDICARE GROUP ID #