Provider Demographics
NPI:1184343865
Name:KITCH, DEVIN BLAKE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:BLAKE
Last Name:KITCH
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 1:3755 S CAPITAL OF TEXAS HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6623
Mailing Address - Country:US
Mailing Address - Phone:512-439-1005
Mailing Address - Fax:
Practice Address - Street 1:3755 S CAPITAL OF TEXAS HWY STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6623
Practice Address - Country:US
Practice Address - Phone:512-439-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1364771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist