Provider Demographics
NPI:1003112756
Name:KALERT, MARY (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KALERT
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 1:924 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2637
Mailing Address - Country:US
Mailing Address - Phone:618-252-7171
Mailing Address - Fax:618-252-7272
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-988-6131
Practice Address - Fax:618-351-4928
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant