Provider Demographics
NPI:1558801183
Name:GARDNER, KAYLA CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHRISTINE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:CHRISTINE
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:HAUGEN
Mailing Address - State:WI
Mailing Address - Zip Code:54841-9399
Mailing Address - Country:US
Mailing Address - Phone:715-530-2810
Mailing Address - Fax:
Practice Address - Street 1:517 E CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6479
Practice Address - Country:US
Practice Address - Phone:715-855-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist