Provider Demographics
NPI:1982048054
Name:HORSEMAN, KYLA (PT)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:HORSEMAN
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 1:3000 WHITEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1308
Mailing Address - Country:US
Mailing Address - Phone:443-421-0668
Mailing Address - Fax:
Practice Address - Street 1:3000 WHITEFIELD RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1308
Practice Address - Country:US
Practice Address - Phone:443-421-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist