Basic Information
| Provider Information | |||||||||
| NPI: | 1033706999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16663 MEDINA RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492479315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679122291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ADRIAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492214309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173121711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2020 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501019855 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.