Healthcare Provider Details

I. General information

NPI: 1730459256
Provider Name (Legal Business Name): KAYLA LYNN HULL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E PINE ST
LAKELAND FL
33801-4965
US

IV. Provider business mailing address

1105 E ORANGE ST #8
LAKELAND FL
33801-5494
US

V. Phone/Fax

Practice location:
  • Phone: 863-397-7531
  • Fax:
Mailing address:
  • Phone: 863-450-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number62615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: