Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2305205933 | VA |
NPI | 1013142652 |
---|---|
Provider Name | Dr. Clint Richard Kalbach |
First Address | Stephens City, VA 22655-2771 |
Second Address | Stephens City, VA 22655-2771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 27/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2305205933 | VIRGINIA STATE PHYSICAL THERAPY LICENSE (01) | VA |