Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brendon Matthew Clark

Individual provider Athletic Trainer · NPI 1114483336

Brendon Matthew Clark is a Physical Therapist in Private Practice in Indianapolis, Indiana. Qualified in 2024, 2 years ago. Practices with Athletico Ltd, a 2,186-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
2
Licensed in
IN
In the registry since
2019
Specialties on file
3
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Practice location Address checks out

5265 E 82nd St Ste 200
Indianapolis, IN 46250-1627
Phone: (317) 542-3723
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 8127 Heathery Pl, Indianapolis, IN 46214-2280 — (317) 246-7549

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 05015804A (IN)
Athletic Trainer Taxonomy 2255A2300X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (IN)

Record details

NPI number1114483336
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 12, 2019
Last updated in NPPESDecember 3, 2024
Certification dateDecember 3, 2024
Mailing address8127 Heathery Pl, Indianapolis, IN 46214-2280

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Athletico Ltd — 2186 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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