# KRISTA JEAN CLARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1114935301
- **Gender:** F
- **Credential:** P.T.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 116187-2401 | UT | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 03/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11618724000001 | BCBS REGENCE OF UTAH | UT |
| 01 | — | 199209 | ALTIUSHEALTH ADMINISTRATO | UT |
| 01 | — | 64-00532 | UNITEDHEALTHCARE | UT |
| 01 | — | 67054 | PEHP | UT |