Provider Demographics
NPI:1831642586
Name:PORTER, KALA (PTA)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:PORTER
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 1:1514 K 96 HWY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3012
Mailing Address - Country:US
Mailing Address - Phone:620-793-5073
Mailing Address - Fax:620-792-2169
Practice Address - Street 1:1514 K 96 HWY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3012
Practice Address - Country:US
Practice Address - Phone:620-793-5073
Practice Address - Fax:620-792-2169
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST04600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant