Provider Demographics
NPI:1902692601
Name:SOMMER, KAYLIN KRISTINE
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:KRISTINE
Last Name:SOMMER
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 1:6736 COUNTY ROAD 108
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-5533
Mailing Address - Country:US
Mailing Address - Phone:817-602-2595
Mailing Address - Fax:
Practice Address - Street 1:401 GAYLORD DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2517
Practice Address - Country:US
Practice Address - Phone:573-642-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic