Provider Demographics
NPI:1023137262
Name:JOHANNE ANDRE KALILE PA
Entity type:Organization
Organization Name:JOHANNE ANDRE KALILE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNE
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:KALILE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-762-9731
Mailing Address - Street 1:1183 OAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6107
Mailing Address - Country:US
Mailing Address - Phone:561-762-9731
Mailing Address - Fax:561-214-4494
Practice Address - Street 1:1183 OAKWATER DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6107
Practice Address - Country:US
Practice Address - Phone:561-762-9731
Practice Address - Fax:561-214-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7174ZMedicare NSC