Provider Demographics
NPI:1467781930
Name:HUGHES, KAY-YATTA MIRA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KAY-YATTA
Middle Name:MIRA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 MARSHALL PL
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2925
Mailing Address - Country:US
Mailing Address - Phone:219-944-2520
Mailing Address - Fax:
Practice Address - Street 1:2279 MARSHALL PL
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-2925
Practice Address - Country:US
Practice Address - Phone:219-944-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003993A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant