Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 42362 | CA |
NPI | 1003213000 |
---|---|
Provider Name | Kate Rose Clarke |
First Address | Solana Beach, CA 92075-2605 |
Second Address | Solana Beach, CA 92075-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 31/03/2020 |