Provider Demographics
NPI:1396364360
Name:MAUST, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MAUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 STUTZMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRIEDENS
Mailing Address - State:PA
Mailing Address - Zip Code:15541-6506
Mailing Address - Country:US
Mailing Address - Phone:814-483-6332
Mailing Address - Fax:
Practice Address - Street 1:1284 STUTZMANTOWN RD
Practice Address - Street 2:
Practice Address - City:FRIEDENS
Practice Address - State:PA
Practice Address - Zip Code:15541-6506
Practice Address - Country:US
Practice Address - Phone:814-483-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605305225200000X
NCA6948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant