Provider Demographics
NPI:1114652146
Name:HEBERT, KAYLIE ALEXANDRA (LMBT)
Entity Type:Individual
Prefix:MS
First Name:KAYLIE
Middle Name:ALEXANDRA
Last Name:HEBERT
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PAVILION WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4559
Mailing Address - Country:US
Mailing Address - Phone:910-315-0402
Mailing Address - Fax:
Practice Address - Street 1:100 PAVILION WAY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4559
Practice Address - Country:US
Practice Address - Phone:910-315-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist