Provider Demographics
NPI:1285208892
Name:GLENN, KAYLA LORIN
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LORIN
Last Name:GLENN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3913
Mailing Address - Country:US
Mailing Address - Phone:727-348-1627
Mailing Address - Fax:
Practice Address - Street 1:2017 CORAL WAY
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3913
Practice Address - Country:US
Practice Address - Phone:727-348-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician