Healthcare Provider Details

I. General information

NPI: 1487069399
Provider Name (Legal Business Name): MARY ALEXANDRA KALAYTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 FOREST AVE
PALO ALTO CA
94301-2608
US

IV. Provider business mailing address

454 FOREST AVE
PALO ALTO CA
94301-2608
US

V. Phone/Fax

Practice location:
  • Phone: 650-331-3700
  • Fax: 650-331-3730
Mailing address:
  • Phone: 650-331-3700
  • Fax: 650-331-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT33655
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT33655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: