Provider Demographics
NPI:1689918757
Name:HUNSUCKER, KAYLA JEANETTE (MPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEANETTE
Last Name:HUNSUCKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5107
Mailing Address - Country:US
Mailing Address - Phone:828-244-1293
Mailing Address - Fax:
Practice Address - Street 1:1315 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4121
Practice Address - Country:US
Practice Address - Phone:336-917-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist