Provider Demographics
NPI:1376998153
Name:KONS, KAYLA (LMT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-2036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 E COLLEGE AVE
Practice Address - Street 2:SUITE H
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3279
Practice Address - Country:US
Practice Address - Phone:920-475-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13000-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist