MEDICARE: KAYLA SMITH MPT

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	2251X0800X	Orthopedic Physical Therapist	19797	CA

General Provider Information

NPI Number	:	1780644708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SMITH MPT

Provider Business Mailing Address
First Line	:	2124 S EL CAMINO REAL STE 100
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6211
Country	:	US
Telephone Number	:	760-901-5040
Fax Number	:	760-433-9221

Provider Business Practice Location Address
First Line	:	2124 S EL CAMINO REAL
Second Line	:	SUITE 100
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6306
Country	:	US
Telephone Number	:	760-901-5040
Fax Number	:	760-433-9221

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/05/2009

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Directions to “ KAYLA SMITH MPT” Practice Location

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