Provider Demographics
NPI:1174195861
Name:MAAG, KALEY
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:MAAG
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 1:335 CHATHAM CT
Mailing Address - Street 2:
Mailing Address - City:WRIGHT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63390-2801
Mailing Address - Country:US
Mailing Address - Phone:636-544-7931
Mailing Address - Fax:
Practice Address - Street 1:3074 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3620
Practice Address - Country:US
Practice Address - Phone:636-265-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist