Provider Demographics
NPI:1285183954
Name:MABRY, KALA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:MARIE
Last Name:MABRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3666
Mailing Address - Country:US
Mailing Address - Phone:361-275-0532
Mailing Address - Fax:361-275-8389
Practice Address - Street 1:2550 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4736
Practice Address - Country:US
Practice Address - Phone:361-275-0532
Practice Address - Fax:361-275-8389
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI219225100000X
TX1237877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist