Healthcare Provider Details

I. General information

NPI: 1992626949
Provider Name (Legal Business Name): KYLE TOLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 RED WOLF BLVD STE H
JONESBORO AR
72401-5453
US

IV. Provider business mailing address

1699 RED WOLF BLVD STE H
JONESBORO AR
72401-5453
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0021
  • Fax: 870-336-0021
Mailing address:
  • Phone: 870-336-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5128
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: