Provider Demographics
NPI:1417202896
Name:SHILLING, KYLE G (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:G
Last Name:SHILLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:#3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-214-0020
Mailing Address - Fax:425-452-0667
Practice Address - Street 1:7900 SE 28TH ST
Practice Address - Street 2:#102
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-6005
Practice Address - Country:US
Practice Address - Phone:206-232-9045
Practice Address - Fax:206-232-8871
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60287663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist