Provider Demographics
NPI:1902546849
Name:FAULKNER, KAYLA ROSE (PT36850)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PT36850
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 SW 158TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1137
Mailing Address - Country:US
Mailing Address - Phone:954-826-1271
Mailing Address - Fax:
Practice Address - Street 1:661 SW 158TH WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1137
Practice Address - Country:US
Practice Address - Phone:954-826-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant