Provider Demographics
NPI:1427361971
Name:HIMMELREICH, KYLE R (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:HIMMELREICH
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 1:450 POWERS AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5933
Mailing Address - Country:US
Mailing Address - Phone:717-920-4950
Mailing Address - Fax:717-920-4955
Practice Address - Street 1:450 POWERS AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5933
Practice Address - Country:US
Practice Address - Phone:717-920-4950
Practice Address - Fax:717-920-4955
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102492178-0001Medicaid
1427361971OtherBERKSHIRE
PA1427361971OtherBRAVO
PA189138VLZMedicare PIN
PA1427361971OtherBRAVO