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General NPI Number Information
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NPI Number | 1376308908
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Entity Type | Individual
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Provider Name | KYLE HIETPAS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 3129 VICENTE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2740
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Country | US
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Telephone | 415-661-1057
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16648-024
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL27686
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP029386T
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-6008
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License Number State | HI
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP034963T
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 307572
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License Number State | CA
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