Provider Demographics
NPI:1659621134
Name:SEMPLE, KAYLA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:SEMPLE
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 1:16031 E 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IL
Mailing Address - Zip Code:62475-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2553
Practice Address - Country:US
Practice Address - Phone:618-395-6031
Practice Address - Fax:618-395-6289
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist