Provider Demographics
NPI:1902191661
Name:HYTREK, KIP A (PTA)
Entity Type:Individual
Prefix:MR
First Name:KIP
Middle Name:A
Last Name:HYTREK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 7TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOOA
Mailing Address - State:IA
Mailing Address - Zip Code:50009
Mailing Address - Country:US
Mailing Address - Phone:515-967-5025
Mailing Address - Fax:515-967-2360
Practice Address - Street 1:3770 8TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1048
Practice Address - Country:US
Practice Address - Phone:515-967-5025
Practice Address - Fax:515-967-2360
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant