Provider Demographics
NPI:1306804042
Name:SAND, KYLA (PT)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:SAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BARNEY CT
Mailing Address - Street 2:APT R
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2919
Mailing Address - Country:US
Mailing Address - Phone:401-595-2944
Mailing Address - Fax:
Practice Address - Street 1:1808 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-625-9855
Practice Address - Fax:401-625-9856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI64-00296OtherUNITED HEALTH
RI13859OtherNEIGHBOR HOOD HEALTH PLAN
RI412576OtherRI BLUE CHIP
RIPT01939OtherTRI-CARE
RI29534-7OtherRI BLUE CROSS BLUE SHEILD