Provider Demographics
NPI:1265065106
Name:OGLESBY, KALIN BRYN (PT)
Entity type:Individual
Prefix:
First Name:KALIN
Middle Name:BRYN
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3303
Mailing Address - Country:US
Mailing Address - Phone:678-390-6166
Mailing Address - Fax:
Practice Address - Street 1:690 DALLAS HWY STE 203
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1263
Practice Address - Country:US
Practice Address - Phone:770-459-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist