Provider Demographics
NPI:1639809056
Name:HEATH, KYLIE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:HEATH
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 1:365 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2159
Mailing Address - Country:US
Mailing Address - Phone:267-644-6315
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY STE 208
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2773
Practice Address - Country:US
Practice Address - Phone:908-847-6756
Practice Address - Fax:908-847-6696
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8180225100000X
NJ40QA02099200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist