Provider Demographics
NPI:1528365293
Name:BLACKWELL, KAYLA COX (PT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:COX
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11451 MOSS SIDE DR
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-7777
Mailing Address - Country:US
Mailing Address - Phone:225-317-2744
Mailing Address - Fax:
Practice Address - Street 1:11451 MOSS SIDE DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-7777
Practice Address - Country:US
Practice Address - Phone:225-317-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics