Mary-Katherine Clark
Individual provider Active NPI Physical Therapist · New Haven, VT
NPI 1487310934 · NPPES record last updated Nov 9, 2021
Key facts
- NPI
- 1487310934
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 040.0134346 (VT)
- Practice address
- 254 Ethan Allen Hwy
New Haven, VT 05472-1045 - Phone
- (802) 388-7259
- NPI assigned
- Nov 9, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Addison County Home Healthand Hospice, Inc
Practice addresses (Care Compare)
254 Ethan Allen Hwy
New Haven, VT 05472-1045
Phone (802) 388-7259
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240507001540 | VT | Practitioner - Physical Therapist in Private Practice | 5193165280 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Addison County Home Health& Hospice, Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
254 Ethan Allen Hwy
New Haven, VT 05472
Phone (802) 388-7259
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 040.0134346 | VT | Yes |
Addresses
Primary practice location
254 Ethan Allen Hwy
New Haven, VT 05472-1045
Mailing address
PO Box 754
Middlebury, VT 05753-0754
Other providers in New Haven, VT
- Addison County Home Health and Hospice, Inc
- Addison County Home Health and Hospice, Inc
- Addison County Home Health& Hospice, Inc.
- Wanda Hier Bouvier
- Hilary Frost Boyle
- Sara Daly
- Dynamic Engagement Institute, L3C
- Michele Aaron Fouts
- Joan Sharon Johnson
- Rebecca Kennedy
All providers in New Haven, VT · Physical Therapist in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.