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NPI Code Detail

MEDICARE: KALLI LETZ

MEDICARE: KALLI LETZ
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 Assistant160.007096IL
2225200000XPhysical Therapy Assistant06006280AIN

General Provider Information

NPI Number : 1790161834
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALLI LETZ
Provider Business Mailing Address
First Line : 10700 PARK PL
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8666
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10700 PARK PL
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8666
Country : US
Telephone Number : 219-351-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2015
Last Update Date : 11/12/2024

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Directions to “ KALLI LETZ ” Practice Location

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