Provider Demographics
NPI:1013722347
Name:SIMONS, CLARK RUSSELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:RUSSELL
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALLEM LN
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-4138
Mailing Address - Country:US
Mailing Address - Phone:267-346-7781
Mailing Address - Fax:
Practice Address - Street 1:230 ROUTE 313 # STORE4
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-3232
Practice Address - Country:US
Practice Address - Phone:267-936-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT033115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist