Provider Demographics
NPI:1922550227
Name:KHOURY, KAYLA CHRISTINE YATES (MS, ATC, CEAS)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:CHRISTINE YATES
Last Name:KHOURY
Suffix:
Gender:F
Credentials:MS, ATC, CEAS
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:CHRISTINE YATES
Other - Last Name:SQUIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, CEAS
Mailing Address - Street 1:5555 E BRIARWOOD AVE APT 2002
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4805
Mailing Address - Country:US
Mailing Address - Phone:719-289-5112
Mailing Address - Fax:
Practice Address - Street 1:3801 BRIGHTON BLVD
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3625
Practice Address - Country:US
Practice Address - Phone:303-299-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00009312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer