Provider Demographics
NPI:1316776792
Name:VILLEGAS, KAYLA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S PARKCREST ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9534
Mailing Address - Country:US
Mailing Address - Phone:480-643-9928
Mailing Address - Fax:
Practice Address - Street 1:633 S PARKCREST ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-9534
Practice Address - Country:US
Practice Address - Phone:480-643-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-24704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist