Provider Demographics
NPI:1881181923
Name:KYLES, MAYA KAMARIA (DPT)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:KAMARIA
Last Name:KYLES
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 1:1726 11TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3811
Mailing Address - Country:US
Mailing Address - Phone:937-422-6489
Mailing Address - Fax:
Practice Address - Street 1:3300 WEBSTER ST STE 703
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3122
Practice Address - Country:US
Practice Address - Phone:510-835-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist