Healthcare Provider Details

I. General information

NPI: 1780644708
Provider Name (Legal Business Name): KAYLA SMITH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 S EL CAMINO REAL SUITE 100
OCEANSIDE CA
92054-6306
US

IV. Provider business mailing address

2124 S EL CAMINO REAL STE 100
OCEANSIDE CA
92054-6211
US

V. Phone/Fax

Practice location:
  • Phone: 760-901-5040
  • Fax: 760-433-9221
Mailing address:
  • Phone: 760-901-5040
  • Fax: 760-433-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number19797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: