Provider Demographics
NPI:1073330585
Name:SISTI, KAYLA (RMP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SISTI
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BATTERY BEND CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-4592
Mailing Address - Country:US
Mailing Address - Phone:443-226-5136
Mailing Address - Fax:
Practice Address - Street 1:107 W EDMONSTON DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1241
Practice Address - Country:US
Practice Address - Phone:240-430-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist