Basic Information
| Provider Information | |||||||||
| NPI: | 1477150928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | KAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2961 24TH AVE S APT 310 | ||||||||
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| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582016185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513565180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S MAIN AVE | ||||||||
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| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2391 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.