Provider Demographics
NPI:1235570003
Name:HARMON, KALA LYNN (PTA, CLT)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:LYNN
Last Name:HARMON
Suffix:
Gender:F
Credentials:PTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-4026
Mailing Address - Country:US
Mailing Address - Phone:940-663-6132
Mailing Address - Fax:940-663-6289
Practice Address - Street 1:402 MERCER ST
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4026
Practice Address - Country:US
Practice Address - Phone:940-663-6132
Practice Address - Fax:940-663-6289
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059339225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant