Provider Demographics
NPI:1659955409
Name:SUWANARAT, KAYLA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:SUWANARAT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BUNNLEVEL
Mailing Address - State:NC
Mailing Address - Zip Code:28323-9158
Mailing Address - Country:US
Mailing Address - Phone:190-440-2078
Mailing Address - Fax:
Practice Address - Street 1:400 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5454
Practice Address - Country:US
Practice Address - Phone:910-829-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist