MEDICARE: KYLE ZWARYCH 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	5501302166	MI

General Provider Information

NPI Number	:	1821712308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ZWARYCH DPT

Provider Business Mailing Address
First Line	:	625 KENMOOR AVE SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2395
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 E BELTLINE AVE NE STE 104
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-4548
Country	:	US
Telephone Number	:	616-577-8336
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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