Dr Kelly Ann Clark, DPT, PT, MT is a
Physical Therapist based in Bloomington, Indiana. Dr Kelly Ann Clark is licensed to practice in Indiana (license number 05013530A) and her current practice location is
2620 N Walnut St, Suite 600, Bloomington, Indiana. She can be reached at her office (for appointments etc.) via phone at
(812) 558-0708.
NPI number for Dr Kelly Ann Clark is 1528614153 and her current mailing address is 2620 N Walnut St, Suite 600, Bloomington, Indiana. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1528614153.
Healthcare Provider's Profile
| Full Name | Dr Kelly Ann Clark |
|---|
| Gender | Female |
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| Speciality | Physical Therapist |
|---|
| Location | 2620 N Walnut St, Bloomington, Indiana |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1528614153
- Provider Enumeration Date: 08/09/2019
- Last Update Date: 08/09/2019
Medical Identifiers
Medical identifiers for Dr Kelly Ann Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528614153 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225700000X | Massage Therapist | MT21304740 (Indiana) | Secondary |
| 225100000X | Physical Therapist | 05013530A (Indiana) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly Ann Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Kelly Ann Clark, DPT, PT, MT
2620 N Walnut St, Suite 600,
Bloomington, IN 47404-2008
Ph: (812) 558-0708 | Dr Kelly Ann Clark, DPT, PT, MT
2620 N Walnut St, Suite 600,
Bloomington, IN 47404-2008
Ph: (812) 558-0708 |
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