Provider Demographics
NPI:1720444540
Name:ANDERSON, KAYLA JANAE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:JANAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-1405
Mailing Address - Country:US
Mailing Address - Phone:360-599-0784
Mailing Address - Fax:
Practice Address - Street 1:960 HARRIS AVE
Practice Address - Street 2:STE 207
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7045
Practice Address - Country:US
Practice Address - Phone:360-599-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT6048276225100000X
CAPT40739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist