Provider Demographics
NPI:1780492272
Name:CANLAS, KYLE JOSEPH ORDONEZ (DOT)
Entity type:Individual
Prefix:
First Name:KYLE JOSEPH
Middle Name:ORDONEZ
Last Name:CANLAS
Suffix:
Gender:M
Credentials:DOT
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:
Other - Last Name:CANLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:6050 TACOMA MALL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5504
Practice Address - Country:US
Practice Address - Phone:253-545-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1398635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist