Provider Demographics
NPI:1437760378
Name:CORREIA, KAALA (DPT)
Entity Type:Individual
Prefix:
First Name:KAALA
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAALA
Other - Middle Name:
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1923 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4601
Mailing Address - Country:US
Mailing Address - Phone:925-930-0545
Mailing Address - Fax:925-930-0717
Practice Address - Street 1:1923 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4601
Practice Address - Country:US
Practice Address - Phone:925-930-0545
Practice Address - Fax:925-930-0717
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist