Provider Demographics
NPI:1861873382
Name:KALLES, DEBORAH LOUISE (PTA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUISE
Last Name:KALLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 - 8TH AVE. SW.
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371
Mailing Address - Country:US
Mailing Address - Phone:253-845-0240
Mailing Address - Fax:
Practice Address - Street 1:601 SO. 8TH ST. - TACOMA SCHOOL DISTRICT
Practice Address - Street 2:ATTENTION: JENNIFER TRAUFLER SPEC. ED. DIRECTOR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-571-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160038241225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty