COLTON CLARK (DPT, PT) – Physical Therapist, NPI 1821973124

COLTON CLARK (DPT, PT) is a healthcare provider. based in Columbus, Mississippi. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials DPT, PT. They hold a License No. PTH12405 (AL). The NPI Number for COLTON CLARK (DPT, PT) is 1821973124

Main info

Male
1 Year Of Experience
Accepts Medicare Assignment
Name
COLTON CLARK (DPT, PT)
NPI
1821973124
Phone
Not provided
Address
199 N BROOKMOORE DR
Enumeration Date
7 August 2025
Last Update Date
7 August 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2565430717
Graduation Year
2025 (1 year ago)
PAC ID
3274033006
Group Practice PAC ID
5597195727
Professional Enrollment ID
I20250825003956
Address ID
AL359065804RA3102XDRXX302
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Digital endpointsOther names

1,477 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AL

Provider Addresses for COLTON CLARK (DPT, PT)

  • 199 N BROOKMOORE DR

    COLUMBUS, MS 397052024

    Phone:

    Type: Mailing

  • 3102 RAINBOW DR STE 200

    RAINBOW CITY, AL 359065804

    Phone: (256) 543-0717

    Fax: (256) 543-0718

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-08-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250825003956IPhysical Therapist In Private PracticeALTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 39705)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5597195727View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeAL
Occupational Therapist In Private PracticeAL
Physical Therapist In Private PracticeAL
-PA
Physical Therapist In Private PracticeAL
Physical Therapist In Private PracticeMS

Reviews

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Frequently asked questions

Where can patients find COLTON CLARK (DPT, PT)'s NPI?
You can confirm COLTON CLARK (DPT, PT) with NPI 1821973124; it appears in the national provider directory.
Is COLTON CLARK (DPT, PT)'s NPI currently valid?
The extract we use shows COLTON CLARK (DPT, PT) as active.
Does COLTON CLARK (DPT, PT) list a primary specialty?
If you are matching referrals, note Physical Therapist for COLTON CLARK (DPT, PT). Clinical services aligned with this taxonomy classification.
Does COLTON CLARK (DPT, PT) practice in Mississippi?
You will see Columbus, Mississippi on file for COLTON CLARK (DPT, PT) alongside any extra practice locations.
Is COLTON CLARK (DPT, PT) a real provider?
This page reflects official NPPES data for NPI 1821973124. Always confirm identity and privileges with the practice and licensing boards.

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