Provider Demographics
NPI:1760284137
Name:JOHNSON, KAYLA YVETTE (PTA)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:YVETTE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:YVETTE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 WOODFIELD LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6301
Practice Address - Country:US
Practice Address - Phone:904-660-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant