MEDICARE: KYLIE CLARK PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305217669	VA

General Provider Information

NPI Number	:	1346177706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE CLARK PT, DPT

Provider Business Mailing Address
First Line	:	1550 WILSON BLVD STE 105
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2435
Country	:	US
Telephone Number	:	571-487-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 WILSON BLVD STE 105
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2435
Country	:	US
Telephone Number	:	571-487-8301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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