Basic Information
| Provider Information | |||||||||
| NPI: | 1659665107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHALER | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 PIKE RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276134043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195000069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 SE CARY PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194609955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2011 | ||||||||
| LastUpdateDate: | 06/01/2011 | ||||||||
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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 | 225200000X | 3866 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.