Provider Demographics
NPI:1477164416
Name:YEAGER, KYLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:YEAGER
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 1:8925 LADY MADONNA CIR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2889
Mailing Address - Country:US
Mailing Address - Phone:317-407-0862
Mailing Address - Fax:
Practice Address - Street 1:814 S PERRY ST STE D
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1942
Practice Address - Country:US
Practice Address - Phone:303-814-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36176225100000X
COPTL0017362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist