Healthcare Provider Details

I. General information

NPI: 1306804042
Provider Name (Legal Business Name): KYLA SAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 MAIN RD
TIVERTON RI
02878-4625
US

IV. Provider business mailing address

9 BARNEY CT APT R
NEWPORT RI
02840-2919
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-9855
  • Fax: 401-625-9856
Mailing address:
  • Phone: 401-595-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01939
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: