Provider Demographics
NPI:1407922958
Name:KYTTLE, BRENDA (MPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:KYTTLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 ROUTE 315
Mailing Address - Street 2:PRO REHABILITATION SERVICES
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-823-7761
Mailing Address - Fax:570-822-8033
Practice Address - Street 1:1086 ROUTE 315
Practice Address - Street 2:PRO REHABILITATION SERVICES
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-823-7761
Practice Address - Fax:570-822-8033
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009783L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508796OtherBLUE SHIELD
393525OtherHEALTH AMERICA ASSURANCE
818043OtherFIRST PRIORITY
815881OtherFIRST PRIORITY
818044OtherFIRST PRIORITY
388442OtherHEALTH AMERICA ASSURANCE
393526OtherHEATH AMERICA ASSURANCE