Provider Demographics
NPI:1184968190
Name:CLARKE, KIRSTEN OVERSBY (DPT)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:OVERSBY
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 1:2006 W LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2406
Mailing Address - Country:US
Mailing Address - Phone:509-573-4816
Mailing Address - Fax:509-573-4825
Practice Address - Street 1:2006 W LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2406
Practice Address - Country:US
Practice Address - Phone:509-573-4816
Practice Address - Fax:509-573-4825
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU 60312979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist