Provider Demographics
NPI:1518213065
Name:PERRY, KAYLA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S. JAMES ST
Mailing Address - Street 2:BOUTON PHYSICAL THERAPY
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-337-1436
Mailing Address - Fax:315-337-1437
Practice Address - Street 1:221 S. JAMES ST
Practice Address - Street 2:BOUTON PHYSICAL THERAPY
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-337-1436
Practice Address - Fax:315-337-1437
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-035162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist