Provider Demographics
NPI:1750999884
Name:SIS, KAYLA (DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SIS
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 1:1044 N 1275 W
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:IN
Mailing Address - Zip Code:47920-8029
Mailing Address - Country:US
Mailing Address - Phone:320-267-3157
Mailing Address - Fax:
Practice Address - Street 1:35 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-3835
Practice Address - Country:US
Practice Address - Phone:765-446-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013769A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist