Basic Information
| Provider Information | |||||||||
| NPI: | 1336506336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLAUBAUGH | ||||||||
| FirstName: | KALAIS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | KUHLMANN | ||||||||
| OtherFirstName: | KALAIS | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 850 43RD AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612658401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097432070 | ||||||||
| FaxNumber: | 3097432073 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 W BRIDGE RD | ||||||||
| Address2: | STE A | ||||||||
| City: | POLK CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502262219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159846377 | ||||||||
| FaxNumber: | 5159846782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2016 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 080282 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.