Provider Demographics
NPI:1932297090
Name:KALOLA, MINAL A (LPT)
Entity Type:Individual
Prefix:MRS
First Name:MINAL
Middle Name:A
Last Name:KALOLA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WOODWARD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3363
Mailing Address - Country:US
Mailing Address - Phone:732-360-1100
Mailing Address - Fax:732-360-1170
Practice Address - Street 1:14 WOODWARD DR
Practice Address - Street 2:SUITE B
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3363
Practice Address - Country:US
Practice Address - Phone:732-360-1100
Practice Address - Fax:732-360-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00940300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048661Medicare ID - Type Unspecified