MEDICARE: KYLE JORDAN OLANDT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	297691	CA

General Provider Information

NPI Number	:	1073158440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE JORDAN OLANDT DPT

Provider Business Mailing Address
First Line	:	32261 CAMINO CAPISTRANO
Second Line	:	STE D101
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3747
Country	:	US
Telephone Number	:	818-421-4745
Fax Number	:

Provider Business Practice Location Address
First Line	:	32261 CAMINO CAPISTRANO
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3746
Country	:	US
Telephone Number	:	818-421-4745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/21/2019

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