=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821591397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE TOMAS MILLER PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2018
-----------------------------------------------------
Last Update Date | 01/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 653 ACADEMY DR
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-686-3235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21841 N BURNING TREE CT
-----------------------------------------------------
City | KILDEER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60047-2904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-714-5419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070.023530
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTL.0015362
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------