Provider Demographics
NPI:1801407994
Name:EIBEN, KAYLA (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:EIBEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6855
Mailing Address - Country:US
Mailing Address - Phone:513-701-6104
Mailing Address - Fax:
Practice Address - Street 1:1814 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8196
Practice Address - Country:US
Practice Address - Phone:859-356-4600
Practice Address - Fax:859-356-4611
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-007981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist