Provider Demographics
NPI:1346005246
Name:CHESTER, KYLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:CHESTER
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 1:1734 DISCOVERY FALLS DR UNIT 141
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2040
Mailing Address - Country:US
Mailing Address - Phone:714-906-4769
Mailing Address - Fax:
Practice Address - Street 1:1734 DISCOVERY FALLS DR UNIT 141
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2040
Practice Address - Country:US
Practice Address - Phone:714-906-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA302541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies