Provider Demographics
NPI:1528112067
Name:MCKIM, KARLA LISETTA (PT)
Entity type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:LISETTA
Last Name:MCKIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1082 HIGHWAY 89 S
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-3965
Mailing Address - Country:US
Mailing Address - Phone:573-897-3890
Mailing Address - Fax:573-897-2762
Practice Address - Street 1:1082 HIGHWAY 89 S
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-3965
Practice Address - Country:US
Practice Address - Phone:573-897-3890
Practice Address - Fax:573-897-2762
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000174770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist