Provider Demographics
NPI:1952132243
Name:WHITE, KYLE JEFFREY (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JEFFREY
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 E PACKARD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8729
Mailing Address - Country:US
Mailing Address - Phone:714-280-5620
Mailing Address - Fax:
Practice Address - Street 1:1076 W CHANDLER BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5223
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist