Provider Demographics
NPI:1013142652
Name:KALBACH, CLINT RICHARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:RICHARD
Last Name:KALBACH
Suffix:
Gender:M
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-0490
Mailing Address - Country:US
Mailing Address - Phone:540-247-1751
Mailing Address - Fax:
Practice Address - Street 1:120 JACKSON RIVER RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465-2416
Practice Address - Country:US
Practice Address - Phone:540-468-6400
Practice Address - Fax:540-468-3301
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205933208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305205933OtherVIRGINIA STATE PHYSICAL THERAPY LICENSE