Provider Demographics
NPI:1023329422
Name:WONG, KAYLA (LMT)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 E ALTAMONTE DR # 108-308
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4628
Mailing Address - Country:US
Mailing Address - Phone:850-225-5224
Mailing Address - Fax:
Practice Address - Street 1:580 CAPE COD LN STE 9
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2144
Practice Address - Country:US
Practice Address - Phone:850-225-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist