MEDICARE: KYLE PHAM 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
1	225100000X	Physical Therapist	PT301453	CA

General Provider Information

NPI Number	:	1972262558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE PHAM PT, DPT

Provider Business Mailing Address
First Line	:	9563 LAGUNA SPRINGS DR STE 200
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9563 LAGUNA SPRINGS DR STE 200
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8205
Country	:	US
Telephone Number	:	916-691-9822
Fax Number	:

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

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	05/24/2024

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