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NPI Code Detail

MEDICARE: KAYLA MARIE ANTRY PTA

MEDICARE: KAYLA MARIE ANTRY PTA
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
1225200000XPhysical Therapy Assistant160.007214IL

General Provider Information

NPI Number : 1467817668
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA MARIE ANTRY PTA
Provider Business Mailing Address
First Line : 404 WILLOW RUN DR
Second Line :
City : RED BUD
State : IL
Zip : 62278-2412
Country : US
Telephone Number : 618-381-4341
Fax Number :
Provider Business Practice Location Address
First Line : 2218 W GRAND AVE
Second Line :
City : ARTESIA
State : NM
Zip : 88210-1624
Country : US
Telephone Number : 575-746-2731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2015
Last Update Date : 12/15/2015

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