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General NPI Number Information
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NPI Number | 1477030682
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Entity Type | Individual
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Provider Name | KALI BRYAN PTA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 2218 W GRAND AVE
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City | ARTESIA
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State | NM
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Zip | 88210-1624
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Country | US
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Telephone | 575-748-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 TEAK LN
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City | CARLSBAD
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State | NM
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Zip | 88220-6621
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Country | US
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Telephone | 303-521-2396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA1524
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License Number State | NM
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