Healthcare Provider Details

I. General information

NPI: 1568202349
Provider Name (Legal Business Name): KAYLA MARIE HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BURNETTS WAY STE 230
SUFFOLK VA
23434-8168
US

IV. Provider business mailing address

6858 BRIAR RIDGE CIR
ROANOKE VA
24018-6900
US

V. Phone/Fax

Practice location:
  • Phone: 757-942-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216633
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: