Provider Demographics
NPI:1164710760
Name:PRIMEAU, KYLE ROBERT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:PRIMEAU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 W RIVERWALK CIR UNIT 0
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7112
Mailing Address - Country:US
Mailing Address - Phone:303-901-9725
Mailing Address - Fax:
Practice Address - Street 1:2943 W RIVERWALK CIR UNIT 0
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7112
Practice Address - Country:US
Practice Address - Phone:303-901-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-11361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist