Provider Demographics
NPI:1861748600
Name:CLINTON, CARA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:CLINTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:MARIE
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1321 N NORTHWOOD CENTER CT
Mailing Address - Street 2:STE B
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4944
Mailing Address - Country:US
Mailing Address - Phone:858-279-5570
Mailing Address - Fax:858-279-5303
Practice Address - Street 1:3959 RUFFIN RD STE J
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1830
Practice Address - Country:US
Practice Address - Phone:858-279-5570
Practice Address - Fax:858-279-5303
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist