Active NPI
Kayla Jean Mabamba, PT
- Physical Therapist
- Saint Paul, MN
National Provider Identifier
1174407027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11730
- Practice address
- 8365 Fairchild Ave
Saint Paul, MN 55112-6122 - Phone
- (507) 676-0463
- NPI assigned
- Aug 4, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11730 | MN | Primary |
Addresses
Primary practice location
8365 Fairchild Ave
Saint Paul, MN 55112-6122
Mailing address
8365 Fairchild Ave
Saint Paul, MN 55112-6122
Phone (507) 676-0463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11730 | MN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754265600000",
"number": "1174407027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8365 FAIRCHILD AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551126122",
"telephone_number": "507-676-0463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8365 FAIRCHILD AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551126122",
"telephone_number": "507-676-0463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MABAMBA",
"first_name": "KAYLA",
"middle_name": "JEAN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-08-04",
"last_updated": "2025-08-04",
"certification_date": "2025-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.