Provider Demographics
NPI:1881106979
Name:ANDERSON, MIKYLA FELICIANO (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MIKYLA
Middle Name:FELICIANO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MIKYLA
Other - Middle Name:FELICIANO
Other - Last Name:VASTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4705 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1938
Mailing Address - Country:US
Mailing Address - Phone:682-553-0258
Mailing Address - Fax:
Practice Address - Street 1:1600 FM 544 # 200
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4591
Practice Address - Country:US
Practice Address - Phone:214-295-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1290753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist