Provider Demographics
NPI:1053629584
Name:VON KALINOWSKI, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:VON KALINOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-505-5400
Mailing Address - Fax:858-505-5459
Practice Address - Street 1:9610 GRANITE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2684
Practice Address - Country:US
Practice Address - Phone:858-505-5400
Practice Address - Fax:858-505-5459
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist