Kimberly A Clark, PT
Individual provider Active NPI Physical Therapist · Bristol, VT
NPI 1902900293 · NPPES record last updated Feb 6, 2020
Key facts
- NPI
- 1902900293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 0400002918 (VT)
- Practice address
- 614 Monkton Rd
Bristol, VT 05443-5392 - Phone
- (802) 349-1808
- Fax
- (802) 453-2988
- NPI assigned
- Sep 8, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200529000495 | VT | Practitioner - Physical Therapist in Private Practice | 4082035126 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0400002918 | VT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Physical Therapy & Bodywork, PLC | Current |
Accepting new patients |
Locations
614 Monkton Rd
Bristol, VT 05443
Phone (802) 222-0436
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 040.0002918 | VT | |
| Physical Therapist | 225100000X | 0400002918 | VT | Yes |
Addresses
Primary practice location
614 Monkton Rd
Bristol, VT 05443-5392
Mailing address
621 Split Rock Rd
New Haven, VT 05472-2106
Phone (802) 877-9929
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6702477 | Medicaid | VT |
Other providers in Bristol, VT
- Teresa Marie Burns
- Chiropractic Health & Wellness PC
- Clark Physical Therapy & Bodywork, PLC
- Charles Edward Clark
- Isabelle G Clark
- Michelle Cobb
- Brendan C Conroy
- Cassandra Corcoran
- James K Cossaart
- Lindsey Victoria Coward
All providers in Bristol, 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 Feb 6, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.