Provider Demographics
NPI:1457629479
Name:ULRICH, KYLE LOUIS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LOUIS
Last Name:ULRICH
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 1:26522 LA ALAMEDA STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8579
Mailing Address - Country:US
Mailing Address - Phone:949-582-2555
Mailing Address - Fax:949-582-3567
Practice Address - Street 1:26522 LA ALAMEDA STE 100
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8579
Practice Address - Country:US
Practice Address - Phone:949-582-2555
Practice Address - Fax:949-582-3567
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB212387OtherMEDICARE ID