Provider Demographics
NPI:1760036552
Name:COTHRAN, KAYLA MARLENE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARLENE
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3023
Mailing Address - Country:US
Mailing Address - Phone:407-416-5718
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5836
Practice Address - Country:US
Practice Address - Phone:407-416-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29555225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant