Healthcare Provider Details

I. General information

NPI: 1023442084
Provider Name (Legal Business Name): KAYLA E MARTIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ELIZABETH VANCE PT, DPT

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/02/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARSHFIELD MEDICAL CENTER NEILLSVILLE N3708 RIVER AVENUE
NEILLSVILLE WI
54456-7218
US

IV. Provider business mailing address

MARSHFIELD MEDICAL CENTER NEILLSVILLE N3708 RIVER AVENUE
NEILLSVILLE WI
54456-7218
US

V. Phone/Fax

Practice location:
  • Phone: 715-819-8274
  • Fax: 715-743-6242
Mailing address:
  • Phone: 715-819-8274
  • Fax: 715-743-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013028746
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13529
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: