MEDICARE: KALLE CARR DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2008027616	MO

General Provider Information

NPI Number	:	1245626506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALLE CARR DPT

Provider Business Mailing Address
First Line	:	8116 STATE HIGHWAY V
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-8193
Country	:	US
Telephone Number	:	417-343-4616
Fax Number	:

Provider Business Practice Location Address
First Line	:	8116 STATE HIGHWAY V
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-8193
Country	:	US
Telephone Number	:	417-343-4616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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Directions to “ KALLE CARR DPT” Practice Location

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