Provider Demographics
NPI:1699973149
Name:LARUE, KALI JEANNE (DPT)
Entity type:Individual
Prefix:MS
First Name:KALI
Middle Name:JEANNE
Last Name:LARUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:
Other - Last Name:SPOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 AYRAULT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8981
Mailing Address - Country:US
Mailing Address - Phone:585-425-1018
Mailing Address - Fax:
Practice Address - Street 1:790 AYRAULT ROAD
Practice Address - Street 2:STAR PHYSICAL THERAPY
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-425-1018
Practice Address - Fax:585-425-8955
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP578262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic