Healthcare Provider Details

I. General information

NPI: 1700501988
Provider Name (Legal Business Name): DYLAN KITTILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29800 HOOVER RD
WARREN MI
48093-3483
US

IV. Provider business mailing address

15326 CAMDEN AVE
EASTPOINTE MI
48021-1504
US

V. Phone/Fax

Practice location:
  • Phone: 586-574-3444
  • Fax:
Mailing address:
  • Phone: 586-871-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502006501
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: