Provider Demographics
NPI:1720571243
Name:STUBBS, KAYLA LARANZA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LARANZA
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 DODSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5813
Mailing Address - Country:US
Mailing Address - Phone:229-894-8320
Mailing Address - Fax:
Practice Address - Street 1:2164 DODSON WOODS DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5813
Practice Address - Country:US
Practice Address - Phone:229-894-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000324282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty