Healthcare Provider Details

I. General information

NPI: 1134722903
Provider Name (Legal Business Name): KYLE AARON PEARSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MOUNTAIN LEDGE STE 3
WILTON NY
12831-2588
US

IV. Provider business mailing address

6 MOUNTAIN LEDGE STE 3
WILTON NY
12831-2588
US

V. Phone/Fax

Practice location:
  • Phone: 978-353-9191
  • Fax:
Mailing address:
  • Phone: 978-353-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: