Provider Demographics
NPI:1003213000
Name:CLARKE, KATE ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ROSE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 DEL MAR SHORES TER
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2605
Mailing Address - Country:US
Mailing Address - Phone:858-999-1663
Mailing Address - Fax:
Practice Address - Street 1:174 DEL MAR SHORES TER
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2605
Practice Address - Country:US
Practice Address - Phone:858-999-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist