Provider Demographics
NPI:1790073062
Name:GALL, KARI LIN (PTA)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LIN
Last Name:GALL
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 1:2601 FOX RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5341
Mailing Address - Country:US
Mailing Address - Phone:605-260-0918
Mailing Address - Fax:605-260-0912
Practice Address - Street 1:2601 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5341
Practice Address - Country:US
Practice Address - Phone:605-260-0918
Practice Address - Fax:605-260-0912
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant