Provider Demographics
NPI:1093497570
Name:ROTHROCK, KAYLA IVERSON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:IVERSON
Last Name:ROTHROCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:14601 RIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2364
Mailing Address - Country:US
Mailing Address - Phone:804-921-7100
Mailing Address - Fax:
Practice Address - Street 1:14601 RIDGE POINT DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2364
Practice Address - Country:US
Practice Address - Phone:804-921-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist