Provider Demographics
NPI:1508576182
Name:PEREZ, KAYLA R (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1343
Mailing Address - Country:US
Mailing Address - Phone:732-965-4713
Mailing Address - Fax:
Practice Address - Street 1:90 RUGBY RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1707
Practice Address - Country:US
Practice Address - Phone:732-965-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00281800207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine