Provider Demographics
NPI:1548801301
Name:SWEETEN, KYLE DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:SWEETEN
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 1:9759 SAN JOSE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5418
Mailing Address - Country:US
Mailing Address - Phone:904-288-0900
Mailing Address - Fax:904-288-0599
Practice Address - Street 1:9759 SAN JOSE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5418
Practice Address - Country:US
Practice Address - Phone:904-288-0900
Practice Address - Fax:904-288-0599
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist