MEDICARE: KAREN CLARK PT

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	3903	KY

General Provider Information

NPI Number	:	1710923008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN CLARK PT

Provider Business Mailing Address
First Line	:	5020 S CROSS POINT CT
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3295
Country	:	US
Telephone Number	:	859-317-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	5006 ATWOOD DR
Second Line	:	SUITE 2
City	:	RICHMOND
State	:	KY
Zip	:	40475-8179
Country	:	US
Telephone Number	:	859-623-2057
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/12/2013

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