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General NPI Number Information
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NPI Number | 1770352445
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Entity Type | Individual
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Provider Name | KYTAN JOSEPHINE TENCLEVE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 5833 W I 20
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City | ARLINGTON
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State | TX
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Zip | 76017-1057
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Country | US
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Telephone | 817-561-1115
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Fax | 817-516-1104
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Provider Business Mailing Address
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Address Line | 2240 RAINBOW RD
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City | CONWAY
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State | AR
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Zip | 72032-2568
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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 |
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License Number State |
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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 | CP033544T
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License Number State | TX
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