MEDICARE: KLARE PHYSICAL THERAPY, PC

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	261QP2000X	Physical Therapy Clinic/Center	1096576	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6400153	OTHER	TX	UNITED HEALTHCARE
2	1747277	OTHER	TX	FIRST HEALTH
3	7019083	OTHER	TX	AETNA INSURANCE
4	83755T	OTHER	TX	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1861671919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLARE PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	702 E MIMOSA ST
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4151
Country	:	US
Telephone Number	:	361-729-8838
Fax Number	:	361-729-9508

Provider Business Practice Location Address
First Line	:	702 E MIMOSA ST
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4151
Country	:	US
Telephone Number	:	361-729-8838
Fax Number	:	361-729-9508

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH WADE KLARE
Credential	:	LPT
Telephone Number	:	361-729-8838

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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Directions to “KLARE PHYSICAL THERAPY, PC ” Practice Location

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