Provider Demographics
NPI:1023597689
Name:PERRY, KYLE THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:PERRY
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 1:5315 TIGER LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-7868
Mailing Address - Country:US
Mailing Address - Phone:801-903-8276
Mailing Address - Fax:
Practice Address - Street 1:1020 QUEENSGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9123
Practice Address - Country:US
Practice Address - Phone:509-578-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist