Provider Demographics
NPI:1013684745
Name:DISCIULLO, KAYLA JUNE (PTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JUNE
Last Name:DISCIULLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8038
Mailing Address - Country:US
Mailing Address - Phone:802-876-1000
Mailing Address - Fax:802-876-1029
Practice Address - Street 1:47 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8038
Practice Address - Country:US
Practice Address - Phone:802-876-1000
Practice Address - Fax:802-876-1029
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0105904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant