Basic Information
| Provider Information | |||||||||
| NPI: | 1174001531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONY | ||||||||
| FirstName: | KAYLEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10080 BRISTOL CT | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129527389 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23100 EUCALYPTUS AVE STE C | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514854594 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2018 | ||||||||
| LastUpdateDate: | 07/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.