Provider Demographics
NPI:1861688293
Name:BROOKHART, KYLE (MPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BROOKHART
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 AVENUE OF THE STARS
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9015
Mailing Address - Country:US
Mailing Address - Phone:972-731-0055
Mailing Address - Fax:972-731-0056
Practice Address - Street 1:2601 AVENUE OF THE STARS
Practice Address - Street 2:SUITE 300
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9015
Practice Address - Country:US
Practice Address - Phone:972-731-0055
Practice Address - Fax:972-731-0056
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L4054Medicare PIN