Provider Demographics
NPI:1861671919
Name:KLARE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:KLARE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:KLARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:361-729-8838
Mailing Address - Street 1:702 E MIMOSA ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-4151
Mailing Address - Country:US
Mailing Address - Phone:361-729-8838
Mailing Address - Fax:361-729-9508
Practice Address - Street 1:702 E MIMOSA ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-4151
Practice Address - Country:US
Practice Address - Phone:361-729-8838
Practice Address - Fax:361-729-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096576261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6400153OtherUNITED HEALTHCARE
TX1747277OtherFIRST HEALTH
TX7019083OtherAETNA INSURANCE
TX83755TOtherBLUE CROSS / BLUE SHIELD