| NPI | 1588995674 |
|---|---|
| Former Name | KAYLA THATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207034) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P12781) |
| 225100000X Physical Therapist (Licence: SC 6133) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2019-11-10 |