MEDICARE: KYLA SAND PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT01939	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64-00296	OTHER	RI	UNITED HEALTH
2	13859	OTHER	RI	NEIGHBOR HOOD HEALTH PLAN
3	412576	OTHER	RI	RI BLUE CHIP
4	PT01939	OTHER	RI	TRI-CARE
5	29534-7	OTHER	RI	RI BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1306804042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLA SAND PT

Provider Business Mailing Address
First Line	:	9 BARNEY CT
Second Line	:	APT R
City	:	NEWPORT
State	:	RI
Zip	:	02840-2919
Country	:	US
Telephone Number	:	401-595-2944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 MAIN RD
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-4625
Country	:	US
Telephone Number	:	401-625-9855
Fax Number	:	401-625-9856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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Directions to “ KYLA SAND PT” Practice Location

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