Healthcare Provider Details

I. General information

NPI: 1447167481
Provider Name (Legal Business Name): KYLE KILLIAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 9TH ST
MARINA CA
93933-6039
US

IV. Provider business mailing address

15 CIELO VISTA TER
MONTEREY CA
93940-6006
US

V. Phone/Fax

Practice location:
  • Phone: 831-884-1000
  • Fax:
Mailing address:
  • Phone: 561-281-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7541
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: