MEDICARE: MR. KYLE HANS PALACIOS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083049902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE HANS PALACIOS DPT

Provider Business Mailing Address
First Line	:	18771 HOYT CIR
Second Line	:	APT. 14
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-1798
Country	:	US
Telephone Number	:	773-709-0826
Fax Number	:

Provider Business Practice Location Address
First Line	:	18771 HOYT CIR
Second Line	:	APT. 14
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-1798
Country	:	US
Telephone Number	:	773-709-0826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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