Provider Demographics
NPI:1104539287
Name:KURATA, KYLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:KURATA
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 1:1005 PACIFIC COAST HWY UNIT A2
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6214
Mailing Address - Country:US
Mailing Address - Phone:562-598-5500
Mailing Address - Fax:562-598-5550
Practice Address - Street 1:1005 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6214
Practice Address - Country:US
Practice Address - Phone:562-598-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist