Provider Demographics
NPI:1689297905
Name:GOLD, KAYLA LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:LYNN
Last Name:GOLD
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 1:51 CEDAR GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1377
Mailing Address - Country:US
Mailing Address - Phone:908-616-0627
Mailing Address - Fax:
Practice Address - Street 1:51 CEDAR GROVE LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1377
Practice Address - Country:US
Practice Address - Phone:908-616-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01914300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist