Provider Demographics
NPI:1215658125
Name:BORASKI, KYLE STEVEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:BORASKI
Suffix:
Gender:M
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 1:1111 HOWARD GAP RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-0018
Mailing Address - Country:US
Mailing Address - Phone:828-681-2162
Mailing Address - Fax:
Practice Address - Street 1:1111 HOWARD GAP RD UNIT A
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-0018
Practice Address - Country:US
Practice Address - Phone:828-681-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist