Provider Demographics
NPI:1518212653
Name:WALLING, KYLE (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WALLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1660 MEDICAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1413
Mailing Address - Country:US
Mailing Address - Phone:239-514-1708
Mailing Address - Fax:239-566-2143
Practice Address - Street 1:1660 MEDICAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1413
Practice Address - Country:US
Practice Address - Phone:239-514-1708
Practice Address - Fax:239-566-2143
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ40467AMedicare PIN