Healthcare Provider Details

I. General information

NPI: 1346176187
Provider Name (Legal Business Name): KAILA KONA-NICOLE MANN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 SE 192ND AVE
CAMAS WA
98607-7415
US

IV. Provider business mailing address

1905 SE 192ND AVE STE 109
CAMAS WA
98607-7415
US

V. Phone/Fax

Practice location:
  • Phone: 360-210-5440
  • Fax:
Mailing address:
  • Phone: 360-210-5440
  • Fax: 360-210-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66128
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70152717-CP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: