Provider Demographics
NPI:1194578781
Name:AUSTIN, KYLEE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:
Last Name:AUSTIN
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 1:7242 E TYNDALL ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-0961
Mailing Address - Country:US
Mailing Address - Phone:480-550-1003
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST STE 215
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3474
Practice Address - Country:US
Practice Address - Phone:480-269-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist