Provider Demographics
NPI:1851806483
Name:FLECK, KALYN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KALYN
Middle Name:
Last Name:FLECK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KALYN
Other - Middle Name:
Other - Last Name:LAPPIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2445 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-3711
Mailing Address - Country:US
Mailing Address - Phone:518-477-2967
Mailing Address - Fax:
Practice Address - Street 1:2445 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-3711
Practice Address - Country:US
Practice Address - Phone:518-477-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002546-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty