Healthcare Provider Details

I. General information

NPI: 1497992143
Provider Name (Legal Business Name): KATHERINE MELISSA KLARE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2009
Last Update Date: 01/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WEST SHORE BLVD SUITE 601
TAMPA FL
33609-1140
US

IV. Provider business mailing address

763 SCHERRY AVE
INDEPENDENCE KY
41051-9333
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-2191
  • Fax:
Mailing address:
  • Phone: 859-630-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004547
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: