Provider Demographics
NPI:1194081471
Name:BOTTEN, KYLE CURTIS (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:CURTIS
Last Name:BOTTEN
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 1:1910 N CHURCH ST
Mailing Address - Street 2:STE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5666
Mailing Address - Country:US
Mailing Address - Phone:336-274-7480
Mailing Address - Fax:336-274-8903
Practice Address - Street 1:1712 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3419
Practice Address - Country:US
Practice Address - Phone:910-483-9300
Practice Address - Fax:910-483-9302
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12128225100000X
NCP14302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist