Provider Demographics
NPI:1285115352
Name:TENBOER, KYLE ALAN (DPT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ALAN
Last Name:TENBOER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19035 W CAPITOL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2755
Mailing Address - Country:US
Mailing Address - Phone:262-695-6744
Mailing Address - Fax:262-695-6466
Practice Address - Street 1:19035 W CAPITOL DR STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2755
Practice Address - Country:US
Practice Address - Phone:262-695-6744
Practice Address - Fax:262-695-6466
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14413-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist