Provider Demographics
NPI:1619634961
Name:DOLEZAL, AKAYLA MARIE
Entity Type:Individual
Prefix:
First Name:AKAYLA
Middle Name:MARIE
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E VISTA BONITA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-9507
Mailing Address - Country:US
Mailing Address - Phone:480-577-1373
Mailing Address - Fax:
Practice Address - Street 1:2215 E VISTA BONITA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-9507
Practice Address - Country:US
Practice Address - Phone:480-577-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer