Provider Demographics
NPI:1750006904
Name:RYAN, KAILA (PT)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:RYAN
Suffix:
Gender:
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:PO BOX 3102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-1102
Mailing Address - Country:US
Mailing Address - Phone:978-460-1466
Mailing Address - Fax:
Practice Address - Street 1:4133 MOUNT ALBERTINE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3128
Practice Address - Country:US
Practice Address - Phone:978-460-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016291225100000X
MA24123225100000X
CA305738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist