Healthcare Provider Details

I. General information

NPI: 1245710342
Provider Name (Legal Business Name): KYLE DIROBERTO PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 SILAS DEANE HWY
ROCKY HILL CT
06067-1309
US

IV. Provider business mailing address

362 CAVAN LN # 362
GLASTONBURY CT
06033-2487
US

V. Phone/Fax

Practice location:
  • Phone: 860-733-1200
  • Fax: 860-866-4288
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012732
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23843
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: