Healthcare Provider Details

I. General information

NPI: 1689290280
Provider Name (Legal Business Name): KAYLA MICHELLE SMITH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA MICHELE LEAL PT, DPT

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 HIGHWAY 62 65 N STE 4
HARRISON AR
72601-1970
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 870-704-4076
  • Fax: 870-741-0089
Mailing address:
  • Phone: 423-238-7212
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2022017736
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4894
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: