Provider Demographics
NPI:1821569773
Name:BOLAND, KALI (DPT)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:BOLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 HEZEL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6375
Mailing Address - Country:US
Mailing Address - Phone:314-960-1184
Mailing Address - Fax:
Practice Address - Street 1:12750 HEZEL LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6375
Practice Address - Country:US
Practice Address - Phone:314-960-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1304990225100000X
MSCP000067T225100000X
NC18154225100000X
MO2018044340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist