Provider Demographics
NPI:1265058895
Name:FLOWERS, KAILEY ELAINE (PTA)
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:ELAINE
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KAILEY
Other - Middle Name:ELAINE
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 280
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-0360
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:2400 EMPIRE CENTRAL DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:469-364-8680
Practice Address - Fax:855-275-2406
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2153568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant