Healthcare Provider Details

I. General information

NPI: 1548740236
Provider Name (Legal Business Name): KRISTEN ANNE KALUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LONGVIEW RD
MISSOURI VALLEY IA
51555-1227
US

IV. Provider business mailing address

14811 ORCHARD CIR
OMAHA NE
68137-1418
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2264
  • Fax:
Mailing address:
  • Phone: 402-990-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1244
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: