Provider Demographics
NPI:1235636655
Name:TUTOKEY, KAILYN LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:LEIGH
Last Name:TUTOKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAILYN
Other - Middle Name:L
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:534 E PINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5536
Mailing Address - Country:US
Mailing Address - Phone:209-463-5800
Mailing Address - Fax:209-463-5900
Practice Address - Street 1:840 S FAIRMONT AVE STE 5
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5105
Practice Address - Country:US
Practice Address - Phone:209-339-1690
Practice Address - Fax:209-339-1693
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA026404225100000X
CA294762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist