Provider Demographics
NPI:1417684507
Name:KYAK, NICHOLAS JOSEPH (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:KYAK
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 1:5530 WISCONSIN AVE STE 1660
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4322
Mailing Address - Country:US
Mailing Address - Phone:301-986-9100
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 1660
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4322
Practice Address - Country:US
Practice Address - Phone:301-986-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist