Mr Dallas Layne Clark, PT is a medicare enrolled "Physical Therapist" provider in Diamondville, Wyoming. He graduated from medical school in 1987 and has 37 years of diverse experience with area of expertise as Physical Therapy. His current practice location is
20 Adaville Drive, Suite 10, Diamondville, Wyoming. You can reach out to his office (for appointments etc.) via phone at
(307) 877-1000.
Mr Dallas Layne Clark is licensed to practice in Wyoming (license number 802) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1972693497.
Healthcare Provider's Profile
| Full Name | Mr Dallas Layne Clark |
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| Gender | Male |
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| Speciality | Physical Therapy |
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| Experience | 37 Years |
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| Location | 20 Adaville Drive, Diamondville, Wyoming |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mr Dallas Layne Clark graduated from medical school in 1987
NPI Data:
- NPI Number: 1972693497
- Provider Enumeration Date: 10/13/2006
- Last Update Date: 07/09/2007
Medicare PECOS Information:
- PECOS PAC ID: 0042262115
- Enrollment ID: I20050217000654
Medical Identifiers
Medical identifiers for Mr Dallas Layne Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1972693497 | NPI | - | NPPES |
| 2282218 | Other | WY | FIRST HEALTH PROVIDER NUM |
| 5586872 | Other | WY | CCN PROVIDER NUMBER |
| 313318 | Other | WY | BLUE CROSS BLUE SHIELD |
| 11433480 | Other | WY | CAQH PROVIDER ID |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225100000X | Physical Therapist | 6293691-2401 (Utah) | Secondary |
| 225100000X | Physical Therapist | 802 (Wyoming) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Dallas Layne Clark allows following entities to bill medicare on his behalf.
| Provider Name | Pro Physical Therapy Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1164619078
PECOS PAC ID: 2163474230
Enrollment ID: O20050216000943 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Dallas Layne Clark is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Dallas Layne Clark, PT
Po Box 152,
Laketown, UT 84038-0152
Ph: (435) 946-3512 | Mr Dallas Layne Clark, PT
20 Adaville Drive, Suite 10,
Diamondville, WY 83116
Ph: (307) 877-1000 |
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