Basic Information
Provider Information
NPI: 1285042655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BALAJTHY
FirstName: KALLIE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: D.P.T., M.S., A.T.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3435 WINCHESTER RD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181042268
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Practice Location
Address1: 505 INDEPENDENCE RD
Address2:  
City: EAST STROUDSBURG
State: PA
PostalCode: 18301
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/29/2014
LastUpdateDate: 06/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT024774PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X25075MDN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X2305208715VAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2255A2300XRT004872PAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer

No ID Information.


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