Provider Demographics
NPI:1962746248
Name:ENAYATI, KAILEY A (DPT)
Entity type:Individual
Prefix:DR
First Name:KAILEY
Middle Name:A
Last Name:ENAYATI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LILAC CIR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6480
Mailing Address - Country:US
Mailing Address - Phone:518-420-4930
Mailing Address - Fax:
Practice Address - Street 1:33 LILAC CIR
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-6480
Practice Address - Country:US
Practice Address - Phone:518-420-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist