Healthcare Provider Details

I. General information

NPI: 1730003351
Provider Name (Legal Business Name): KYLE POULIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALFRED ST
WOBURN MA
01801-1976
US

IV. Provider business mailing address

7 ALFRED ST
WOBURN MA
01801-1976
US

V. Phone/Fax

Practice location:
  • Phone: 781-281-2391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number89569
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: