Individual
KIMBERLY A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
614 MONKTON RD, BRISTOL, VT 05443-5392
(802) 349-1808
(802) 453-2988
Mailing address
621 SPLIT ROCK RD, NEW HAVEN, VT 05472-2106
(802) 877-9929
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
040.0002918
VT
225100000X
Physical Therapist
Primary
0400002918
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6702477
—
VT
Enumeration date
09/08/2006
Last updated
02/06/2020
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