Provider Demographics
NPI:1699276113
Name:KEGARISE, KALA BROWN (PT)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:BROWN
Last Name:KEGARISE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700B E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-5101
Mailing Address - Country:US
Mailing Address - Phone:903-736-8328
Mailing Address - Fax:
Practice Address - Street 1:700B E LAKE DR
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-5101
Practice Address - Country:US
Practice Address - Phone:903-736-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1370898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist