Basic Information
| Provider Information | |||||||||
| NPI: | 1659348175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSS | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177573537 | ||||||||
| FaxNumber: | 7177188674 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177573537 | ||||||||
| FaxNumber: | 7177188674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 26906 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT007247L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000965444 | 01 | HIGHMARK BLUE SHIELD | OTHER | 50162511 | 01 | CAPITAL BLUE CROSS | OTHER | 001664800 | 05 | PA | MEDICAID |