Provider Demographics
NPI:1083267009
Name:NORTHERN, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NORTHERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 MEXBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36445-3520
Mailing Address - Country:US
Mailing Address - Phone:251-362-8285
Mailing Address - Fax:
Practice Address - Street 1:1080 MEXBORO RD
Practice Address - Street 2:
Practice Address - City:FRISCO CITY
Practice Address - State:AL
Practice Address - Zip Code:36445-3520
Practice Address - Country:US
Practice Address - Phone:251-362-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA8479225200000X
CAPTA50022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant