Healthcare Provider Details

I. General information

NPI: 1770352445
Provider Name (Legal Business Name): KYTAN JOSEPHINE TENCLEVE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 W I 20
ARLINGTON TX
76017-1057
US

IV. Provider business mailing address

2240 RAINBOW RD
CONWAY AR
72032-2568
US

V. Phone/Fax

Practice location:
  • Phone: 817-561-1115
  • Fax: 817-516-1104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP033544T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: