Provider Demographics
NPI:1831963578
Name:VAILLANCOURT, KAYLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:VAILLANCOURT
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 MILL RD
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-9709
Mailing Address - Country:US
Mailing Address - Phone:716-969-2236
Mailing Address - Fax:
Practice Address - Street 1:8 HOSPITAL CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-8702
Practice Address - Country:US
Practice Address - Phone:843-671-7342
Practice Address - Fax:843-671-7343
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22702225100000X
SC12778225100000X
NY050983-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation