Provider Demographics
NPI:1528094307
Name:CLARKE, NANCY J (MA, PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:CLARKE-KINNIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, PT
Mailing Address - Street 1:1 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1754
Mailing Address - Country:US
Mailing Address - Phone:518-273-2121
Mailing Address - Fax:518-273-0701
Practice Address - Street 1:1 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1754
Practice Address - Country:US
Practice Address - Phone:518-273-2121
Practice Address - Fax:518-273-0701
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013341-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
575793Medicare UPIN
025406Medicare ID - Type Unspecified