Provider Demographics
NPI:1013764133
Name:BUTLER, KAYLA DARSAM
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DARSAM
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23001 DEL LAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1354
Mailing Address - Country:US
Mailing Address - Phone:949-387-7333
Mailing Address - Fax:
Practice Address - Street 1:23001 DEL LAGO DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1354
Practice Address - Country:US
Practice Address - Phone:949-387-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant