Basic Information
| Provider Information | |||||||||
| NPI: | 1578977294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEARY | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6313 SALEM PARK CIR | ||||||||
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| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170502838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179792439 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1419 KNECHT AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212271415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102479595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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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 | 225100000X | 037380 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.