Provider Demographics
NPI:1518658475
Name:EAST, KAILA REA (PTA)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:REA
Last Name:EAST
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 1:5400 E REVOLUTIONARY WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6716
Mailing Address - Country:US
Mailing Address - Phone:907-414-0188
Mailing Address - Fax:
Practice Address - Street 1:234 FOURTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-4210
Practice Address - Country:US
Practice Address - Phone:866-238-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK142490225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant