Provider Demographics
NPI:1780397844
Name:REYNOLDS, KYLE T (DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:T
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:T
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:921 N 600 E
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:208-994-2579
Practice Address - Street 1:360 S STATE ST # C110
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5729
Practice Address - Country:US
Practice Address - Phone:801-850-9146
Practice Address - Fax:801-373-7486
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist