Healthcare Provider Details

I. General information

NPI: 1013142652
Provider Name (Legal Business Name): CLINT RICHARD KALBACH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 JACKSON RIVER RD
MONTEREY VA
24465-2416
US

IV. Provider business mailing address

PO BOX 490
MONTEREY VA
24465-0490
US

V. Phone/Fax

Practice location:
  • Phone: 540-468-6400
  • Fax: 540-468-3301
Mailing address:
  • Phone: 540-247-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2305205933
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205933
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: