MEDICARE: KRISTOPHER KYLE THARP PT, 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	PT3768	AR

General Provider Information

NPI Number	:	1174330989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOPHER KYLE THARP PT, DPT

Provider Business Mailing Address
First Line	:	551 CEDAR GROVE RD
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-8008
Country	:	US
Telephone Number	:	870-307-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 CEDAR GROVE RD
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-8008
Country	:	US
Telephone Number	:	870-307-8877
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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