Healthcare Provider Details

I. General information

NPI: 1114372513
Provider Name (Legal Business Name): KYLIE TIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 THIRD AVE
SYKESVILLE MD
21784-5201
US

IV. Provider business mailing address

7200 THIRD AVE
SYKESVILLE MD
21784-5201
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-8800
  • Fax:
Mailing address:
  • Phone: 410-795-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038881
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: