Provider Demographics
NPI:1972974822
Name:WATTS, KYLIE N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:N
Last Name:WATTS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:M
Other - Last Name:NOVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:2 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4265
Practice Address - Country:US
Practice Address - Phone:864-797-7320
Practice Address - Fax:864-797-7325
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264811225100000X
SC8076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist