MEDICARE: MR. KEVIN GENE CALE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT2366	OK

General Provider Information

NPI Number	:	1215990452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN GENE CALE PT

Provider Business Mailing Address
First Line	:	3549 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7015
Country	:	US
Telephone Number	:	405-749-7950
Fax Number	:	405-749-7940

Provider Business Practice Location Address
First Line	:	3549 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7015
Country	:	US
Telephone Number	:	405-749-7950
Fax Number	:	405-749-7940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	06/10/2011

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