MEDICARE: MR. KYLE WARNER 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	025701-1	NY

General Provider Information

NPI Number	:	1871686113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE WARNER DPT

Provider Business Mailing Address
First Line	:	485 CENTRAL PARK W
Second Line	:	#3F
City	:	NEW YORK
State	:	NY
Zip	:	10025-3322
Country	:	US
Telephone Number	:	646-470-8615
Fax Number	:	212-409-8204

Provider Business Practice Location Address
First Line	:	485 CENTRAL PARK W
Second Line	:	#3F
City	:	NEW YORK
State	:	NY
Zip	:	10025-3322
Country	:	US
Telephone Number	:	646-470-8615
Fax Number	:	212-409-8204

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	06/04/2019

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