Provider Demographics
NPI:1811871080
Name:BURKE, KAYLA NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 INDIAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3458
Mailing Address - Country:US
Mailing Address - Phone:501-803-8968
Mailing Address - Fax:
Practice Address - Street 1:805 WEST ST
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2949
Practice Address - Country:US
Practice Address - Phone:870-247-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5032225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant