Provider Demographics
NPI:1063134005
Name:KELLY, KAYLA REY (DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:REY
Last Name:KELLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BRIDGE ST # 2
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2933
Mailing Address - Country:US
Mailing Address - Phone:207-351-6742
Mailing Address - Fax:
Practice Address - Street 1:25 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1167
Practice Address - Country:US
Practice Address - Phone:207-647-6145
Practice Address - Fax:207-647-6065
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist