Healthcare Provider Details

I. General information

NPI: 1467319970
Provider Name (Legal Business Name): KYLIE MARIE RONNING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CABRILLO COLLEGE DR
APTOS CA
95003-3166
US

IV. Provider business mailing address

5435 ENTRANCE DR
SOQUEL CA
95073-2719
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-3901
  • Fax:
Mailing address:
  • Phone: 831-345-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: