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NPI Code Detail

MEDICARE: KYLE YEAGER PT, DPT

MEDICARE: KYLE YEAGER PT, 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
1225100000XPhysical TherapistPT36176FL
2225100000XPhysical TherapistPTL0017362CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477164416
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE YEAGER PT, DPT
Provider Business Mailing Address
First Line : 8925 LADY MADONNA CIR UNIT 305
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80129-2889
Country : US
Telephone Number : 317-407-0862
Fax Number :
Provider Business Practice Location Address
First Line : 814 S PERRY ST STE D
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80104-1942
Country : US
Telephone Number : 303-814-2865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 11/09/2020

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