Provider Demographics
NPI:1740073709
Name:WITTE, KYLIE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:MARIE
Last Name:WITTE
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 1:2900 THOMAS AVE S APT 1912
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4198
Mailing Address - Country:US
Mailing Address - Phone:320-248-7887
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST STE 290
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2133
Practice Address - Country:US
Practice Address - Phone:952-836-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist