Provider Demographics
NPI:1174912984
Name:MIKESCH, KAILA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:NICOLE
Last Name:MIKESCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:N
Other - Last Name:BEQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 FESTUS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2458
Mailing Address - Country:US
Mailing Address - Phone:636-224-7511
Mailing Address - Fax:636-638-2199
Practice Address - Street 1:3950 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3790
Practice Address - Country:US
Practice Address - Phone:636-461-0900
Practice Address - Fax:636-461-0047
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist