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General NPI Number Information
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NPI Number | 1063015972
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Entity Type | Individual
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Provider Name | KAYLA MATTHEWS PT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 9600 GROSS POINT RD
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City | SKOKIE
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State | IL
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Zip | 60076-1214
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Country | US
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Telephone | 847-933-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 720 N LARRABEE ST APT 1012
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City | CHICAGO
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State | IL
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Zip | 60654-5066
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Country | US
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Telephone | 949-243-4651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025404
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License Number State | IL
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