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General NPI Number Information
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NPI Number | 1841620374
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Entity Type | Individual
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Provider Name | YASSER G. EL KALLA PT,ATC,LAT
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Gender | Male
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 303 N HURSTBOURNE PKWY SUITE 200
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City | LOUISVILLE
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State | KY
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Zip | 40222-5185
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Country | US
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Telephone | 502-412-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 303 N HURSTBOURNE PKWY SUITE 200
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City | LOUISVILLE
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State | KY
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Zip | 40222-5185
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Country | US
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Telephone | 502-412-5847
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05011308A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36002205A
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License Number State | IN
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