Provider Demographics
NPI:1831716430
Name:PRICE, KYLA OLIVIA (PT DPT)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:OLIVIA
Last Name:PRICE
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:OLIVIA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:1504 NAVAL AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3038
Mailing Address - Country:US
Mailing Address - Phone:360-713-2043
Mailing Address - Fax:
Practice Address - Street 1:1550 NE RIDDELL RD STE 170
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3060
Practice Address - Country:US
Practice Address - Phone:360-474-3274
Practice Address - Fax:360-824-6720
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60757671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60757671OtherSTATE LICENSE