Provider Demographics
NPI:1154634855
Name:MARKWAY, KYLE CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:MARKWAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 DIAMOND RDG STE 800
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-7906
Mailing Address - Country:US
Mailing Address - Phone:573-761-9360
Mailing Address - Fax:573-761-9362
Practice Address - Street 1:1002 DIAMOND RDG STE 800
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-7906
Practice Address - Country:US
Practice Address - Phone:573-761-9360
Practice Address - Fax:573-761-9362
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024031092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist