Provider Demographics
NPI:1336747062
Name:SORIENTE, KYLE SANTOS (DPT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SANTOS
Last Name:SORIENTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 OMOHUNDRO AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1414
Mailing Address - Country:US
Mailing Address - Phone:703-489-5495
Mailing Address - Fax:
Practice Address - Street 1:3310 OMOHUNDRO AVE UNIT B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1414
Practice Address - Country:US
Practice Address - Phone:703-489-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist