Provider Demographics
NPI:1013565068
Name:WALENTA, KYLE JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:WALENTA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 VANTAGE WAY APT 2429
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1641
Mailing Address - Country:US
Mailing Address - Phone:616-818-5366
Mailing Address - Fax:
Practice Address - Street 1:315 14TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3416
Practice Address - Country:US
Practice Address - Phone:615-321-5698
Practice Address - Fax:615-321-5538
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist