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General NPI Number Information
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NPI Number | 1841294899
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Entity Type | Individual
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Provider Name | WALTER K. CLEARY P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 1480 18TH ST
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City | CORBIN
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State | KY
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Zip | 40701-2721
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Country | US
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Telephone | 606-528-0870
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Fax | 606-528-3449
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Provider Business Mailing Address
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Address Line | 1480 18TH ST
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City | CORBIN
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State | KY
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Zip | 40701-2721
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Country | US
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Telephone | 606-528-0891
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Fax | 606-528-3449
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1263
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 966
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License Number State | KY
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