Provider Demographics
NPI:1013950211
Name:SIMPSON, CLARK E (LAT/ATC)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:E
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 E. 400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356
Mailing Address - Country:US
Mailing Address - Phone:765-779-0004
Mailing Address - Fax:765-779-0005
Practice Address - Street 1:3831 E. 400 SOUTH
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356
Practice Address - Country:US
Practice Address - Phone:765-779-0004
Practice Address - Fax:765-779-0005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN360001952255A2300X
226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist