Provider Demographics
NPI:1871070599
Name:HARRIS, KYLA R (DPT)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:R
Last Name:HARRIS
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 1:3051 CABERNET DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8644
Mailing Address - Country:US
Mailing Address - Phone:406-282-1030
Mailing Address - Fax:406-422-0626
Practice Address - Street 1:3051 CABERNET DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8644
Practice Address - Country:US
Practice Address - Phone:406-282-1030
Practice Address - Fax:406-422-0626
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-15041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist