Provider Demographics
NPI:1417265497
Name:SLEDGE, KALA C (PTA)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:C
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900A NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2593
Mailing Address - Country:US
Mailing Address - Phone:402-616-4570
Mailing Address - Fax:
Practice Address - Street 1:1203 EAST 23RD AVENUE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-0000
Practice Address - Country:US
Practice Address - Phone:620-663-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402096225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant