Provider Demographics
NPI:1114108842
Name:VALLETTE, KARA LEE (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEE
Last Name:VALLETTE
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 1:555 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-4345
Mailing Address - Country:US
Mailing Address - Phone:618-252-6306
Mailing Address - Fax:
Practice Address - Street 1:607 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2345
Practice Address - Country:US
Practice Address - Phone:618-252-7171
Practice Address - Fax:618-252-7272
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist