Provider Demographics
NPI:1205292075
Name:GARCIA, KAYLEIGH NICOLE (PT)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:NICOLE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:
Other - Last Name:WALTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2074 ANTILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5209
Mailing Address - Country:US
Mailing Address - Phone:325-690-9700
Mailing Address - Fax:325-690-9704
Practice Address - Street 1:1059 N JUDGE ELY BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3853
Practice Address - Country:US
Practice Address - Phone:325-232-8500
Practice Address - Fax:325-232-8400
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3118701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1272096OtherLICENSE