Healthcare Provider Details

I. General information

NPI: 1336558089
Provider Name (Legal Business Name): NICHOLAS KYLE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FIELDVIEW AVE
MORGANTOWN WV
26501-1114
US

IV. Provider business mailing address

101 FIELDVIEW AVE
MORGANTOWN WV
26501-1114
US

V. Phone/Fax

Practice location:
  • Phone: 304-554-2220
  • Fax: 304-404-2048
Mailing address:
  • Phone: 304-554-2220
  • Fax: 304-404-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003372
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: