Provider Demographics
NPI:1609391259
Name:LANCE, KAYLAN BROOKE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KAYLAN
Middle Name:BROOKE
Last Name:LANCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SPENCER MULL RD
Mailing Address - Street 2:
Mailing Address - City:PENROSE
Mailing Address - State:NC
Mailing Address - Zip Code:28766-8823
Mailing Address - Country:US
Mailing Address - Phone:828-577-7176
Mailing Address - Fax:
Practice Address - Street 1:59 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3951
Practice Address - Country:US
Practice Address - Phone:828-966-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist