Provider Demographics
NPI:1962968644
Name:YBARRA, KAYLA ROSE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:ROSE
Last Name:YBARRA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:ROSE
Other - Last Name:YBARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1904 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3106
Mailing Address - Country:US
Mailing Address - Phone:956-585-2439
Mailing Address - Fax:
Practice Address - Street 1:1904 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-585-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1315912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1315912OtherPT LICENSE