Provider Demographics
NPI:1447502794
Name:EGBERT, KAILEY LYNN (DPT)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:LYNN
Last Name:EGBERT
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 1:3250 HARDEN STREET EXT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6842
Mailing Address - Country:US
Mailing Address - Phone:803-509-6389
Mailing Address - Fax:803-509-6390
Practice Address - Street 1:3250 HARDEN STREET EXT
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6842
Practice Address - Country:US
Practice Address - Phone:803-509-6389
Practice Address - Fax:803-509-6390
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist