Provider Demographics
NPI:1497992143
Name:KLARE, KATHERINE MELISSA (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MELISSA
Last Name:KLARE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 SCHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9333
Mailing Address - Country:US
Mailing Address - Phone:859-630-6264
Mailing Address - Fax:
Practice Address - Street 1:600 N WEST SHORE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1140
Practice Address - Country:US
Practice Address - Phone:800-632-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004547225100000X
FL24528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist