Provider Demographics
NPI:1124581640
Name:SCHUNK, KAYLA LYNN (LPTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:SCHUNK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LONG BLVD APT 635
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6808
Mailing Address - Country:US
Mailing Address - Phone:989-928-7182
Mailing Address - Fax:
Practice Address - Street 1:5091 WILLOUGHBY RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1054
Practice Address - Country:US
Practice Address - Phone:517-694-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003870225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant