Provider Demographics
NPI:1558040071
Name:AIKEN, KYLIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:AIKEN
Suffix:
Gender:F
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 1:325 HUNTWICK CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7230
Mailing Address - Country:US
Mailing Address - Phone:678-772-6204
Mailing Address - Fax:
Practice Address - Street 1:16172 AIRLINE HWY STE B
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4212
Practice Address - Country:US
Practice Address - Phone:225-255-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist