Provider Demographics
NPI:1528337714
Name:HAYTER, KARLA RENEE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:RENEE
Last Name:HAYTER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2506
Mailing Address - Country:US
Mailing Address - Phone:708-386-1831
Mailing Address - Fax:708-386-4291
Practice Address - Street 1:320 N LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2506
Practice Address - Country:US
Practice Address - Phone:708-386-1831
Practice Address - Fax:708-386-4291
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist