Provider Demographics
NPI:1770039281
Name:HOLLSTADT, KAYLA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HOLLSTADT
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 1:117 EVERGREEN DR
Mailing Address - Street 2:ATTN: DISEPIO INSTITUTE CENTER FOR REHABILITATION
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-9704
Mailing Address - Country:US
Mailing Address - Phone:814-471-1112
Mailing Address - Fax:814-472-3905
Practice Address - Street 1:14000 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5713
Practice Address - Country:US
Practice Address - Phone:952-993-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist