Healthcare Provider Details

I. General information

NPI: 1417061219
Provider Name (Legal Business Name): KALTHERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5886 VENTURE PARK
KALAMAZOO MI
49009-1848
US

IV. Provider business mailing address

5886 VENTURE PARK
KALAMAZOO MI
49009-1848
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4737
  • Fax: 269-375-2266
Mailing address:
  • Phone: 269-375-4737
  • Fax: 269-375-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE J OBRYANT
Title or Position: PRESIDENT
Credential: OTR
Phone: 269-375-2200