Individual
KRISTA JEAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
(435) 657-0123
(435) 657-0330
Mailing address
210 E MAIN ST STE 111, MIDWAY, UT 84049-6828
(435) 657-0123
(435) 657-0330
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
116187-2401
UT
Other
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
Enumeration date
08/03/2006
Last updated
03/17/2018
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