Provider Demographics
NPI:1043928039
Name:GERTKEN, KAYLA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GERTKEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:RAUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:307 IVY AVE SE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-4509
Mailing Address - Country:US
Mailing Address - Phone:320-321-0166
Mailing Address - Fax:877-505-4195
Practice Address - Street 1:307 IVY AVE SE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MN
Practice Address - Zip Code:56368-4509
Practice Address - Country:US
Practice Address - Phone:320-321-0166
Practice Address - Fax:877-505-4195
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist