Basic Information
| Provider Information | |||||||||
| NPI: | 1770039281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLSTADT | ||||||||
| FirstName: | KAYLA | ||||||||
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| Credential: | P.T., D.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 EVERGREEN DR | ||||||||
| Address2: | ATTN: DISEPIO INSTITUTE CENTER FOR REHABILITATION | ||||||||
| City: | LORETTO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159409704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144711112 | ||||||||
| FaxNumber: | 8144723905 | ||||||||
| Practice Location | |||||||||
| Address1: | 14000 FAIRVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553375713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529938700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2016 | ||||||||
| LastUpdateDate: | 02/14/2018 | ||||||||
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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 | PT025527 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.