Provider Demographics
NPI:1104433648
Name:ROTE, KAILEY (DPT)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:ROTE
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:PO BOX 3185
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3185
Mailing Address - Country:US
Mailing Address - Phone:907-206-2603
Mailing Address - Fax:844-955-1845
Practice Address - Street 1:1633 S INDUSTRIAL WAY STE B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6713
Practice Address - Country:US
Practice Address - Phone:907-206-2603
Practice Address - Fax:844-955-1845
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECP003564T225100000X
MD28420225100000X
NE4127225100000X
AK183270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist