Provider Demographics
NPI:1801186184
Name:BORMAN, KAYLA (PT, DPT, C/NDT, MBA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BORMAN
Suffix:
Gender:F
Credentials:PT, DPT, C/NDT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2320
Mailing Address - Country:US
Mailing Address - Phone:603-475-9337
Mailing Address - Fax:
Practice Address - Street 1:6 WESTON RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2320
Practice Address - Country:US
Practice Address - Phone:603-475-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216580225100000X
MA19389225100000X
NH4140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist