Provider Demographics
NPI:1417061219
Name:KALTHERAPY PC
Entity type:Organization
Organization Name:KALTHERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:269-375-2200
Mailing Address - Street 1:5886 VENTURE PARK
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1848
Mailing Address - Country:US
Mailing Address - Phone:269-375-4737
Mailing Address - Fax:269-375-2266
Practice Address - Street 1:5886 VENTURE PARK
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1848
Practice Address - Country:US
Practice Address - Phone:269-375-4737
Practice Address - Fax:269-375-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6430152OtherIBA
MI=========OtherPPOM
MI6430152OtherIBA