Provider Demographics
NPI:1477100444
Name:PRADON, KILEY M (DPT)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:M
Last Name:PRADON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:M
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:138 OLD SAN ANTONIO RD STE 304
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3491
Practice Address - Country:US
Practice Address - Phone:210-419-3144
Practice Address - Fax:210-764-5098
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1323529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist