Provider Demographics
NPI:1962718429
Name:CLARKE, KRISTA HOISINGTON (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:HOISINGTON
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26495 NYS RT 3
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4702
Mailing Address - Country:US
Mailing Address - Phone:315-782-0002
Mailing Address - Fax:315-883-1333
Practice Address - Street 1:26495 NYS RT 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4702
Practice Address - Country:US
Practice Address - Phone:315-782-0002
Practice Address - Fax:315-883-1333
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist