Provider Demographics
NPI:1518640267
Name:HERNDEN, KYLE DAVID (PT DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:HERNDEN
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 1:4800 LINTON BLVD STE F116
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6583
Mailing Address - Country:US
Mailing Address - Phone:561-498-1423
Mailing Address - Fax:561-498-7848
Practice Address - Street 1:4800 LINTON BLVD STE F116
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6583
Practice Address - Country:US
Practice Address - Phone:561-498-1423
Practice Address - Fax:561-498-7848
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty