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General NPI Number Information
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NPI Number | 1700459328
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Entity Type | Individual
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Provider Name | KYLA RIKKI WARDALLY MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 11200 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33199-2516
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Country | US
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Telephone | 305-348-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 JOE DIMAGGIO DR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5402
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL17142
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License Number State | FL
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