MEDICARE: DR. KYLE BRADLEY PAXTON 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	2305210177	VA

General Provider Information

NPI Number	:	1184070252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE BRADLEY PAXTON DPT

Provider Business Mailing Address
First Line	:	4410 N CARLIN SPRINGS RD APT 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2031
Country	:	US
Telephone Number	:	585-613-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 N CARLIN SPRINGS RD APT 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2031
Country	:	US
Telephone Number	:	585-613-6108
Fax Number	:

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

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/09/2016

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