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NPI Code Detail

MEDICARE: KALI BRYAN PTA

MEDICARE: KALI BRYAN 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 AssistantPTA1524NM

General Provider Information

NPI Number : 1477030682
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALI BRYAN PTA
Provider Business Mailing Address
First Line : 1100 TEAK LN
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-6621
Country : US
Telephone Number : 303-521-2396
Fax Number :
Provider Business Practice Location Address
First Line : 2218 W GRAND AVE
Second Line :
City : ARTESIA
State : NM
Zip : 88210-1624
Country : US
Telephone Number : 575-748-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2018
Last Update Date : 07/20/2018

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Directions to “ KALI BRYAN PTA” Practice Location

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