Individual
KAYLA A HUERTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
285 FOREST GROVE DR STE 207, PEWAUKEE, WI 53072-3738
(877) 732-2262
Mailing address
700 W ROCK PLACE, GLENDALE, WI 53209
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1721-39
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY,REHABILITATIVE & RESTORATIVE SERVICE PROVIDER
WI
Enumeration date
02/06/2018
Last updated
02/06/2018
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