Basic Information
| Provider Information | |||||||||
| NPI: | 1306804042 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SAND | ||||||||
| FirstName: | KYLA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 BARNEY CT | ||||||||
| Address2: | APT R | ||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028402919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015952944 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1808 MAIN RD | ||||||||
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| City: | TIVERTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028784625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016259855 | ||||||||
| FaxNumber: | 4016259856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT01939 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 64-00296 | 01 | RI | UNITED HEALTH | OTHER | 13859 | 01 | RI | NEIGHBOR HOOD HEALTH PLAN | OTHER | 412576 | 01 | RI | RI BLUE CHIP | OTHER | PT01939 | 01 | RI | TRI-CARE | OTHER | 29534-7 | 01 | RI | RI BLUE CROSS BLUE SHEILD | OTHER |