Provider Demographics
NPI:1952604845
Name:HAUCK, KAYLA (ATC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HAUCK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BROADCASTING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3229
Mailing Address - Country:US
Mailing Address - Phone:610-685-9600
Mailing Address - Fax:
Practice Address - Street 1:1350 BROADCASTING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3229
Practice Address - Country:US
Practice Address - Phone:610-685-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0048122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer