Provider Demographics
NPI:1568928315
Name:LAMBERT, KAYLA AGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:AGAN
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LEIGH
Other - Last Name:AGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:404-367-2085
Mailing Address - Fax:770-579-7060
Practice Address - Street 1:1000 JOHNSON FERRY RD STE A115
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2110
Practice Address - Country:US
Practice Address - Phone:404-367-2085
Practice Address - Fax:770-579-7060
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist