Provider Demographics
NPI:1174120752
Name:GANGIDINE-DALEY, KYLE J (DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:GANGIDINE-DALEY
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 1:1251 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-4917
Mailing Address - Country:US
Mailing Address - Phone:330-928-2273
Mailing Address - Fax:330-922-4088
Practice Address - Street 1:1251 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221
Practice Address - Country:US
Practice Address - Phone:330-928-2273
Practice Address - Fax:330-922-4088
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist