Provider Demographics
NPI:1770352445
Name:TENCLEVE, KYTAN JOSEPHINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYTAN
Middle Name:JOSEPHINE
Last Name:TENCLEVE
Suffix:
Gender:F
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 1:2240 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5833 W I 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1057
Practice Address - Country:US
Practice Address - Phone:817-561-1115
Practice Address - Fax:817-516-1104
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TXCP033544T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist