Provider Demographics
NPI:1811365935
Name:LANCE, KYLE J (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:LANCE
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 1:5426 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-1704
Mailing Address - Country:US
Mailing Address - Phone:908-319-8648
Mailing Address - Fax:
Practice Address - Street 1:5426 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-1704
Practice Address - Country:US
Practice Address - Phone:908-319-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03946237700000X
PAPT024695225100000X
NJ40QA01647300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01647300OtherPT LICENSE