Provider Demographics
NPI:1740164854
Name:STAUFFER, KYLE R (DPT, PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8467
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-8467
Mailing Address - Country:US
Mailing Address - Phone:307-367-3452
Mailing Address - Fax:307-367-3455
Practice Address - Street 1:1100 W WILSON ST STE 8
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-5400
Practice Address - Country:US
Practice Address - Phone:307-367-3452
Practice Address - Fax:307-367-3455
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-2547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist