Provider Demographics
NPI:1447593744
Name:KALTSAS, JESSICA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:KALTSAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 WOODHURST LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1351
Mailing Address - Country:US
Mailing Address - Phone:847-567-9694
Mailing Address - Fax:
Practice Address - Street 1:550 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2544
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9391225200000X
IL160005564225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant