Provider Demographics
NPI:1710476676
Name:WAINMAN, KYLIE J (DPT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:J
Last Name:WAINMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:J
Other - Last Name:LIPPENCOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:1003 MILL POND DR STE C
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2609
Practice Address - Country:US
Practice Address - Phone:765-653-8494
Practice Address - Fax:765-653-7835
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013202A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist