Provider Demographics
NPI:1669059812
Name:RADTKE, KYLE PHILIP (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:PHILIP
Last Name:RADTKE
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 1:16823 MOSSFORD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-1307
Mailing Address - Country:US
Mailing Address - Phone:210-836-4299
Mailing Address - Fax:
Practice Address - Street 1:16823 MOSSFORD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-1307
Practice Address - Country:US
Practice Address - Phone:210-836-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist