Provider Demographics
NPI:1952923419
Name:BURGER, KAYLA (PT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BURGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5168
Mailing Address - Country:US
Mailing Address - Phone:928-517-1157
Mailing Address - Fax:
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6051
Practice Address - Country:US
Practice Address - Phone:208-625-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30418225100000X
MT17043225100000X
ID7042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT17043OtherMONTANA STATE BOARD OF PHYSICAL THERAPY
AZ30418OtherARIZONA STATE BOARD OF PHYSICAL THERAPY
ID7062OtherIDAHO STATE BOARD OF PHYSICAL THERAPY