Provider Demographics
NPI:1720218563
Name:DORRELL, KAYLA K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:K
Last Name:DORRELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:K
Other - Last Name:PELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1679 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2904
Mailing Address - Country:US
Mailing Address - Phone:701-483-1000
Mailing Address - Fax:
Practice Address - Street 1:1679 6TH AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2904
Practice Address - Country:US
Practice Address - Phone:701-483-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant