Provider Demographics
NPI:1942555008
Name:SMITH, KAYLA NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:NICOLE
Other - Last Name:FIRSTIUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1808
Mailing Address - Country:US
Mailing Address - Phone:518-852-0901
Mailing Address - Fax:
Practice Address - Street 1:1270 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2104
Practice Address - Country:US
Practice Address - Phone:518-362-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist