Provider Demographics
NPI:1457803090
Name:RADACH, KYLE BRANDON (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BRANDON
Last Name:RADACH
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 1:1800 HARRISON ST, 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-4101
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2706
Practice Address - Country:US
Practice Address - Phone:209-216-3360
Practice Address - Fax:209-216-3365
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist