Provider Demographics
NPI:1750987624
Name:MANN, KYLIE (DPT)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5664 KATE WAY UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4675
Mailing Address - Country:US
Mailing Address - Phone:909-638-3969
Mailing Address - Fax:
Practice Address - Street 1:9660 HAVEN AVE STE 130
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5897
Practice Address - Country:US
Practice Address - Phone:909-269-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist