Healthcare Provider Details

I. General information

NPI: 1538602792
Provider Name (Legal Business Name): KAYLA SIMMONS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BRABHAM AVE STE 100
JACKSONVILLE NC
28546-0202
US

IV. Provider business mailing address

2716 ASHTON DR
WILMINGTON NC
28412-2489
US

V. Phone/Fax

Practice location:
  • Phone: 910-332-3800
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number16756
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: