Provider Demographics
NPI:1255008959
Name:UTNE, KYLE ANDREW (MA, ATC, PTA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:UTNE
Suffix:
Gender:M
Credentials:MA, ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 PRESTON RD STE T1200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4700
Mailing Address - Country:US
Mailing Address - Phone:469-303-3000
Mailing Address - Fax:
Practice Address - Street 1:7211 PRESTON RD STE T1200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4700
Practice Address - Country:US
Practice Address - Phone:469-303-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT67492255A2300X
TX2151789225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2151789OtherPHYSICAL THERAPIST ASSISTANT LICENSE NUMBER
TXAT6749OtherATHLETIC TRAINERS LICENSURE NUMBER