Healthcare Provider Details

I. General information

NPI: 1003735978
Provider Name (Legal Business Name): KEARSE ELLISON CLOKEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 RAINBOW INDUSTRIAL BLVD
RAINBOW CITY AL
35906-8901
US

IV. Provider business mailing address

114 RAINBOW INDUSTRIAL BLVD
RAINBOW CITY AL
35906-8901
US

V. Phone/Fax

Practice location:
  • Phone: 256-328-5384
  • Fax: 267-367-5905
Mailing address:
  • Phone: 256-328-5384
  • Fax: 267-367-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11948
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: