Provider Demographics
NPI:1932564952
Name:CHASE, KAYLA (PTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:SIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:568 SCENIC HTS
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-1143
Mailing Address - Country:US
Mailing Address - Phone:509-954-9571
Mailing Address - Fax:
Practice Address - Street 1:2219 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2171
Practice Address - Country:US
Practice Address - Phone:509-235-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160106178225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant