Provider Demographics
NPI:1558054593
Name:WARREN, KYRA JANE (DPT)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:JANE
Last Name:WARREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 S JOG RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4164
Mailing Address - Country:US
Mailing Address - Phone:561-733-5083
Mailing Address - Fax:
Practice Address - Street 1:12040 S JOG RD STE 8
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:561-733-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT40230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist