MEDICARE: KYLIE WOLVERTON 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	05015552A	IN

General Provider Information

NPI Number	:	1588593446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE WOLVERTON PT, DPT

Provider Business Mailing Address
First Line	:	1125 WINDHAVEN CIR APT H
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7947
Country	:	US
Telephone Number	:	765-620-1015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 WINDHAVEN CIR APT H
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7947
Country	:	US
Telephone Number	:	765-620-1015
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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