Provider Demographics
NPI:1437740172
Name:MCLAUGHLIN, KALANI
Entity Type:Individual
Prefix:
First Name:KALANI
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BATTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1405
Mailing Address - Country:US
Mailing Address - Phone:808-392-9267
Mailing Address - Fax:
Practice Address - Street 1:120 W IDAHO ST STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3939
Practice Address - Country:US
Practice Address - Phone:406-206-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-13138225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant