Provider Demographics
NPI:1578232542
Name:ENGEL, KAILA MARIE (DPT, PT)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:MARIE
Last Name:ENGEL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:MARIE
Other - Last Name:KIKUGAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:4920 30TH AVE S APT 118
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9025
Mailing Address - Country:US
Mailing Address - Phone:808-753-8004
Mailing Address - Fax:
Practice Address - Street 1:1420 9TH ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3381
Practice Address - Country:US
Practice Address - Phone:701-364-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4279225100000X
ND2793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist