Provider Demographics
NPI:1043669575
Name:EMMETT, KAYLA W (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:W
Last Name:EMMETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-5602
Mailing Address - Country:US
Mailing Address - Phone:770-848-6160
Mailing Address - Fax:
Practice Address - Street 1:1515 RIVER PL
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5602
Practice Address - Country:US
Practice Address - Phone:770-848-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13836979OtherCAQH NUMBER