MEDICARE: KAYLA DIONYSUS BUNTS 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
1	225200000X	Physical Therapy Assistant	2946-19	WI

General Provider Information

NPI Number	:	1871275917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DIONYSUS BUNTS PTA

Provider Business Mailing Address
First Line	:	4026 TOWNE LAKES CIR APT 2208
Second Line	:
City	:	GRAND CHUTE
State	:	WI
Zip	:	54913-8110
Country	:	US
Telephone Number	:	920-382-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	4026 TOWNE LAKES CIR APT 2208
Second Line	:
City	:	GRAND CHUTE
State	:	WI
Zip	:	54913-8110
Country	:	US
Telephone Number	:	920-382-2236
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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