JUSTIN CLARK (NPI# 1285136846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285136846 |
| Entity Type | Individual |
| Full Name | JUSTIN CLARK |
| Credential | BOCO |
| Practice Address |
1844 South St Redding CA 96001-1809 |
| Practice Telephone | 5302434500 |
| Practice Fax Number | 5302434554 |
| Mailing Telephone | 5302434500 |
| Mailing Fax Number | 5302434554 |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GFC000180 | 05 | |
| CA | BLUE SHIELD OF CA | PG0073849001 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1399 Montgomery Rd, Red Bluff, CA 960804604 | 5305282200 | 5305282290 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493226 | Justin Clark | Student in an Organized Health Care Education/Training Program | 7337 Wythe Dr, Noblesville, IN 46062-7785 | 2020-10-08 |
| 1942531868 | Justin Clark | Pharmacist | 12050 N Dove Mt Blvd, Marana, AZ 85658 | 2010-01-15 |
| 1750528964 | Justin Liam Clark | Physical Therapist | 102 Fairview Pk Dr, Elmsford, NY 10523-1518 | 2009-01-09 |
| 1598945644 | Justin Charles Clark | Neurological Surgery | 414 Plymouth Ne, Grand Rapids, MI 49505-6041 | 2007-11-06 |
| 1538129085 | Justin Clark | Allergy & Immunology | 362 Beal Pkwy Nw Ste 105, Fort Walton Beach, FL 32548-3926 | 2006-03-27 |
| 1639164098 | Justin Wayne Clark | Dermatology | 3601 22nd St, Lubbock Dermatology, Lubbock, TX 79410-1309 | 2005-09-13 |
| 1619458999 | Justin Blake Clark | Social Worker | 9600 Veterans Dr., Mailstop: Mhc 61-116-c, Tacoma, WA 98493-5000 | 2018-08-24 |
| 1912483645 | Justin D Clark | Social Worker | 533 26th St Ste 100, Ogden, UT 84401-2459 | 2018-07-16 |
| 1235621327 | Justin M Clark | Family Medicine | 1801 Hickman Rd, Des Moines, IA 50314-1505 | 2018-06-04 |
| 1760987481 | Justin Clark | Occupational Therapist | 14151 15 Mile Rd, Sterling Heights, MI 48312-5507 | 2018-03-26 |
| Street Address |
1844 SOUTH ST |
| City | REDDING |
| State | CA |
| Zip Code | 96001-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639173537 | Spectrum Prosthetics & Orthotics of Redding Inc | Prosthetic/Orthotic Supplier | 1844 South St, Redding, CA 96001-1809 | 2005-06-08 |
| 1750988051 | Kathryn Anderson | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2020-10-08 |
| 1306315593 | Kirk Rose | Prosthetist | 1844 South St, Redding, CA 96001-1809 | 2018-11-16 |
| 1639671290 | Matt Hoffer | Orthotic Fitter | 1844 South St, Redding, CA 96001-1809 | 2018-02-28 |
| 1952802597 | Tina Zeller | Mastectomy Fitter | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1336640978 | Justin Wynhoff | Pedorthist | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1225539869 | Heather Bletcher | Mastectomy Fitter | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1538660170 | Jeff Zeller | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1346741980 | Tyler Rowley | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730651266 | Vanessa Louise Banda | Social Worker | 1544 Magnolia Avenue, Redding, CA 96001 | 2018-12-21 |
| 1184194672 | Marie Sherrick | Licensed Vocational Nurse | 2030 Elreno Lane, Redding, CA 96001 | 2018-11-28 |
| 1699257857 | Prorehab Physical Therapy and Sports Performance, Inc | Physical Therapist | 3673 Eureka Way, Redding, CA 96001 | 2018-09-05 |
| 1316456833 | Jennifer Rose Goehring | Counselor | 1310 Continental Street, Redding, CA 96001 | 2017-09-27 |
| 1891224440 | Audrey Cutler | Social Worker | 1313 Yuba St., Redding, CA 96001 | 2017-06-07 |
| 1184167991 | Calafia Holdings LLC | Skilled Nursing Facility | 1836 Gold Street, Redding, CA 96001 | 2016-11-28 |
| 1194272369 | Shasta County | Clinic/Center | 2950 Polk Street, Rooms 2, 3, 4, Redding, CA 96001 | 2016-09-06 |
| 1417329236 | Shari Hayden | Specialist/Technologist, Other | 2111 Air Park Dr, Redding, CA 96001 | 2015-10-21 |
| 1679951982 | Shasta Hearing Aids | Health Maintenance Organization | 900 Butte St, Redding, CA 96001 | 2015-05-07 |
| 1073919171 | Native American Mental Health Services Corporation | Psychiatry & Neurology | 1742 Oregon Street, Redding, CA 96001 | 2014-11-17 |
| Find all providers in zip 96001 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093903569 | William Brian Snider | Orthotist | 1760 Gold Street, Suite 400, Redding, CA 96001-1800 | 2007-10-10 |
| 1750988051 | Kathryn Anderson | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2020-10-08 |
| 1538660170 | Jeff Zeller | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1346741980 | Tyler Rowley | Orthotist | 1844 South St, Redding, CA 96001-1809 | 2018-02-27 |
| 1013417393 | Justin Michael Tegerstrand | Orthotist | 2102 Civic Center Dr, Redding, CA 96001-2704 | 2018-02-13 |
| 1649770926 | John Morgan | Orthotist | 2102 Civic Center Dr, Redding, CA 96001-2704 | 2018-02-13 |
| 1003316381 | Deanna Hansen | Orthotist | 2102 Civic Center Dr, Redding, CA 96001-2704 | 2018-02-13 |
| 1760670228 | Timothy A Elliott | Orthotist | 2147 Court St, Redding, CA 96001-2531 | 2007-10-10 |
| 1659569234 | Jason Dunphy | Orthotist | 2147 Court St, Redding, CA 96001-2531 | 2007-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780284851 | Hannah Mckinsey Oltrogge | Orthotist | 1260 S Main St Ste 102, Salinas, CA 93901-2292 | 2020-10-28 |
| 1639789779 | Dynamics Orthotics & Prosthetics, Inc | Orthotist | 2150 N Waterman Ave Ste 301, San Bernardino, CA 92404-4811 | 2020-08-04 |
| 1043833619 | Tim Shride | Orthotist | 3800 Watt Ave Ste 151, Sacramento, CA 95821-2688 | 2020-05-18 |
| 1255964854 | Stephanie Janae Ybarra | Orthotist | 5412 Avenida De Los Robles, Suite 101, Visalia, CA 93291 | 2020-02-21 |
| 1558994129 | Jacy Kay Young | Orthotist | 1247 E Alluvial Ave Ste 112, Fresno, CA 93720-2686 | 2020-02-21 |
| 1851935217 | Timothy James Johnston | Orthotist | 635 Anderson Rd., Suite 18, Davis, CA 95616 | 2019-10-29 |
| 1629628243 | Christian Rae Figueroa | Orthotist | 19845 Lake Chabot Rd Ste 302, Castro Valley, CA 94546-4055 | 2019-09-16 |
| 1710534821 | Alpha Iscandari Sanusi | Orthotist | 1760 Chicago Ave Ste L21, Riverside, CA 92507-2326 | 2019-08-22 |
| 1255998290 | West Coast Dme & Supplies LLC | Orthotist | 8322 Clairemont Mesa Blvd Ste 105, San Diego, CA 92111-1317 | 2019-05-24 |
| 1043876162 | Kadesh Gamall Gayle | Orthotist | 20595 Spring St, Riverside, CA 92507-0128 | 2019-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.