Provider Demographics
NPI:1982217667
Name:MARCINAK, KALEY JANEE
Entity Type:Individual
Prefix:DR
First Name:KALEY
Middle Name:JANEE
Last Name:MARCINAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 N 95TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4610
Mailing Address - Country:US
Mailing Address - Phone:480-767-0794
Mailing Address - Fax:480-767-0797
Practice Address - Street 1:9941 N 95TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4610
Practice Address - Country:US
Practice Address - Phone:480-767-0794
Practice Address - Fax:480-767-0797
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-31171OtherAZ STATE LICENSE NUMBER