Provider Demographics
NPI:1356789242
Name:KALKA, KEVIN M (PTA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:KALKA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 WATSON RD STE 136
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5247
Mailing Address - Country:US
Mailing Address - Phone:314-968-4044
Mailing Address - Fax:314-961-6281
Practice Address - Street 1:8460 WATSON RD STE 136
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5247
Practice Address - Country:US
Practice Address - Phone:314-968-4044
Practice Address - Fax:314-961-6281
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant