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General NPI Number Information
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NPI Number | 1679436190
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Entity Type | Individual
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Provider Name | KAYLA AGENTOWICZ
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1095 TEXAS PALMYRA HWY STE 1
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City | HONESDALE
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State | PA
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Zip | 18431-7687
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Country | US
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Telephone | 570-616-0665
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Fax | 570-616-0665
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Provider Business Mailing Address
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Address Line | 446 ROUTE 106 APT D
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City | GREENFIELD TOWNSHIP
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State | PA
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Zip | 18407-3904
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Country | US
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Telephone |
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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 | PT033876
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License Number State | PA
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