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General NPI Number Information
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NPI Number | 1700501988
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Entity Type | Individual
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Provider Name | DYLAN KITTILA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 29800 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-3483
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Country | US
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Telephone | 586-574-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 15326 CAMDEN AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1504
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Country | US
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Telephone | 586-871-1857
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502006501
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License Number State | MI
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