Healthcare Provider Details

I. General information

NPI: 1770872301
Provider Name (Legal Business Name): KAYLA HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10289 GOULD DRIVE
ST. FRANCISVILLE LA
70775
US

IV. Provider business mailing address

1051 E PLAINS PORT HUDSON RD
ZACHARY LA
70791-6102
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-2448
  • Fax:
Mailing address:
  • Phone: 225-301-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA7671
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: