Provider Demographics
NPI:1740569185
Name:WILLIAMSEN, KAYLA ANNE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANNE
Last Name:WILLIAMSEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WESTHILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-7552
Mailing Address - Country:US
Mailing Address - Phone:307-660-6882
Mailing Address - Fax:
Practice Address - Street 1:548 RUNNING W DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2074
Practice Address - Country:US
Practice Address - Phone:307-696-6045
Practice Address - Fax:307-696-6046
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYX502145Medicare UPIN
WYW26956Medicare PIN