Provider Demographics
NPI:1497428171
Name:HIETPAS, KALI ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KALI
Middle Name:ANN
Last Name:HIETPAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KALI
Other - Middle Name:ANN
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2211 HILLSBOROUGH RD APT 1055
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4172
Mailing Address - Country:US
Mailing Address - Phone:715-252-8308
Mailing Address - Fax:
Practice Address - Street 1:900 S FRANKLIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2799
Practice Address - Country:US
Practice Address - Phone:919-556-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12241225100000X
NCP22362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist