Provider Demographics
NPI:1437680527
Name:CHELO, KARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CHELO
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 1:17122 BEACH BLVD
Mailing Address - Street 2:#101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5992
Mailing Address - Country:US
Mailing Address - Phone:714-848-7191
Mailing Address - Fax:714-375-7563
Practice Address - Street 1:17122 BEACH BLVD
Practice Address - Street 2:#101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5992
Practice Address - Country:US
Practice Address - Phone:714-848-7191
Practice Address - Fax:714-375-7563
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 292836225100000X
FLPT 29491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist