Provider Demographics
NPI:1902043268
Name:KERSTEEN KALFAYAN, MARLA ELICE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:ELICE
Last Name:KERSTEEN KALFAYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARLA
Other - Middle Name:ELICE
Other - Last Name:KERSTEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14545 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1131
Mailing Address - Country:US
Mailing Address - Phone:262-797-6909
Mailing Address - Fax:
Practice Address - Street 1:14545 RIDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1131
Practice Address - Country:US
Practice Address - Phone:262-797-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10293-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist