Provider Demographics
NPI:1255105219
Name:WILSON, KAYLEIGH ALEXIS (DPT)
Entity type:Individual
Prefix:DR
First Name:KAYLEIGH
Middle Name:ALEXIS
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2260 TAPO ST STE B117
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3022
Mailing Address - Country:US
Mailing Address - Phone:805-765-4773
Mailing Address - Fax:805-392-9975
Practice Address - Street 1:2260 TAPO ST STE B117
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3022
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:805-392-9975
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist