Provider Demographics
NPI:1104491042
Name:CHRISTOPHER, KYLE AUSTIN (DPT, PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:AUSTIN
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NE PARVIN RD APT 102
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-5009
Mailing Address - Country:US
Mailing Address - Phone:580-919-0194
Mailing Address - Fax:
Practice Address - Street 1:6264 LEWIS DR STE 100
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3603
Practice Address - Country:US
Practice Address - Phone:816-587-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225100000X
KS11-06716225100000X
MO2021024159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-06716OtherKANSAS STATE BOARD OF HEALING ARTS
MO2021024159OtherMISSOURI STATE BOARD OF HEALING ARTS