Provider Demographics
NPI:1346648615
Name:IVES, KAYLA NICHOLE (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICHOLE
Last Name:IVES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:NICHOLE
Other - Last Name:YSTEBOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2806 S 110TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4814
Mailing Address - Country:US
Mailing Address - Phone:402-502-8374
Mailing Address - Fax:
Practice Address - Street 1:2806 S 110TH CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4814
Practice Address - Country:US
Practice Address - Phone:402-502-8374
Practice Address - Fax:402-819-0916
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist