Provider Demographics
NPI:1770904708
Name:ROSSLAND, KAYLA JO (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JO
Last Name:ROSSLAND
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9506 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1104
Mailing Address - Country:US
Mailing Address - Phone:847-927-5260
Mailing Address - Fax:
Practice Address - Street 1:221 UNIVERSITY AVE STE 203
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-580-8788
Practice Address - Fax:701-609-5231
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020255225100000X
ND1832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist