Provider Demographics
NPI:1346219136
Name:KALISH, SUE ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:KALISH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 CROWN MOUNTAIN PL UNIT D100
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1623
Mailing Address - Country:US
Mailing Address - Phone:706-265-5964
Mailing Address - Fax:706-482-0073
Practice Address - Street 1:81 CROWN MOUNTAIN PL UNIT E100
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1623
Practice Address - Country:US
Practice Address - Phone:706-265-5964
Practice Address - Fax:706-482-0073
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919498AMedicaid