Provider Demographics
NPI:1831810316
Name:LEBON, KAYLA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:LEBON
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 1:12643 15TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ND
Mailing Address - Zip Code:58046-9415
Mailing Address - Country:US
Mailing Address - Phone:605-838-5614
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2575225100000X
MEPT6349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist