Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT33655 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT33655 | CA |
NPI | 1487069399 |
---|---|
Provider Name | Dr. Mary Alexandra Kalayta |
First Address | Palo Alto, CA 94301-2608 |
Second Address | Palo Alto, CA 94301-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 30/06/2014 |