Provider Demographics
NPI:1518965615
Name:MATHEWS, KARA CLEMENZ (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:CLEMENZ
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 KING WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-0620
Mailing Address - Country:US
Mailing Address - Phone:434-975-0229
Mailing Address - Fax:
Practice Address - Street 1:198 SPOTNAP RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8614
Practice Address - Country:US
Practice Address - Phone:434-977-6700
Practice Address - Fax:434-977-6779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000864225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant