Provider Demographics
NPI:1295496057
Name:ALBERTELLA, KAYLA (ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ALBERTELLA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18430 MIDWAY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-9536
Mailing Address - Country:US
Mailing Address - Phone:302-753-5730
Mailing Address - Fax:
Practice Address - Street 1:18430 MIDWAY RANCH RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-9536
Practice Address - Country:US
Practice Address - Phone:302-753-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00023572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer