Provider Demographics
NPI:1497813489
Name:STANDLEY, KAY L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:L
Last Name:STANDLEY
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 1:260 WINNSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5377
Mailing Address - Country:US
Mailing Address - Phone:229-883-0353
Mailing Address - Fax:
Practice Address - Street 1:6298 VETERANS PKWY STE 5A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6245
Practice Address - Country:US
Practice Address - Phone:229-320-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant