Provider Demographics
NPI:1407300676
Name:LEDUC, KAYLA (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LEDUC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 1ST ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-4635
Mailing Address - Country:US
Mailing Address - Phone:320-631-2302
Mailing Address - Fax:
Practice Address - Street 1:309 1ST ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-4635
Practice Address - Country:US
Practice Address - Phone:320-631-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist