Provider Demographics
NPI:1609628023
Name:WILSON, KYLER NALANIEHA (DPT)
Entity Type:Individual
Prefix:
First Name:KYLER
Middle Name:NALANIEHA
Last Name:WILSON
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 1:29377 RANCHO CALIFORNIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5206
Mailing Address - Country:US
Mailing Address - Phone:951-296-0400
Mailing Address - Fax:
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5206
Practice Address - Country:US
Practice Address - Phone:951-296-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist