Healthcare Provider Details

I. General information

NPI: 1679436190
Provider Name (Legal Business Name): KAYLA AGENTOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 TEXAS PALMYRA HWY STE 1
HONESDALE PA
18431-7687
US

IV. Provider business mailing address

446 ROUTE 106 APT D
GREENFIELD TOWNSHIP PA
18407-3904
US

V. Phone/Fax

Practice location:
  • Phone: 570-616-0665
  • Fax: 570-616-0665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033876
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: