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NPI Code Detail

MEDICARE: KALA C HALL PTA

MEDICARE: KALA C HALL PTA
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
1225200000XPhysical Therapy AssistantA4506NC

General Provider Information

NPI Number : 1407115751
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALA C HALL PTA
Provider Business Mailing Address
First Line : 4108 GRAND MANOR CT APT 105
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7838
Country : US
Telephone Number : 704-682-4605
Fax Number :
Provider Business Practice Location Address
First Line : 3830 BLUE RIDGE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27612-4319
Country : US
Telephone Number : 919-424-4617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2012
Last Update Date : 05/07/2012

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Directions to “ KALA C HALL PTA” Practice Location

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