Provider Demographics
NPI:1700905916
Name:JONAH-HOURIHAN, KYLA LEE (PT)
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:LEE
Last Name:JONAH-HOURIHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WARDEN LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04739-3049
Mailing Address - Country:US
Mailing Address - Phone:207-444-5152
Mailing Address - Fax:207-444-2878
Practice Address - Street 1:37 CARTER STREET
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:ME
Practice Address - Zip Code:04739-3049
Practice Address - Country:US
Practice Address - Phone:207-444-5152
Practice Address - Fax:207-444-2878
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist