Provider Demographics
NPI:1306859459
Name:PALADINO, KYLE (PT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:PALADINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1800
Mailing Address - Country:US
Mailing Address - Phone:740-454-4651
Mailing Address - Fax:740-454-4653
Practice Address - Street 1:2315 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2028
Practice Address - Country:US
Practice Address - Phone:740-450-1687
Practice Address - Fax:740-450-1693
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0989499OtherGROUP MEDICAID
OH2699209Medicaid
CA1586OtherGROUP MEDICARE RAILROAD
9270902Medicare PIN
OH0989499OtherGROUP MEDICAID