Healthcare Provider Details

I. General information

NPI: 1356174163
Provider Name (Legal Business Name): CALLI LIGHT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CALLI NEAL

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6712 KIMBALL DR
GIG HARBOR WA
98335-1212
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-514-6757
  • Fax: 253-432-4075
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70169347
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216714
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: