Provider Demographics
NPI:1215378799
Name:ZOLLMAN, KALIE MANUEL (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:KALIE
Middle Name:MANUEL
Last Name:ZOLLMAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-1816
Mailing Address - Country:US
Mailing Address - Phone:540-460-4678
Mailing Address - Fax:
Practice Address - Street 1:160 KENDAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-1786
Practice Address - Country:US
Practice Address - Phone:540-463-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602349225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant