MEDICARE: KAILA KONA-NICOLE MANN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	66128	OR

General Provider Information

NPI Number	:	1346176187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILA KONA-NICOLE MANN PT, DPT

Provider Business Mailing Address
First Line	:	1905 SE 192ND AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 SE 192ND AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7415
Country	:	US
Telephone Number	:	360-210-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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Directions to “ KAILA KONA-NICOLE MANN PT, DPT” Practice Location

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