Provider Demographics
NPI:1316811409
Name:CONDON, KYLE MATTHEW (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MATTHEW
Last Name:CONDON
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 1:610 FREEDOM BUSINESS CTR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1329
Mailing Address - Country:US
Mailing Address - Phone:484-224-7913
Mailing Address - Fax:484-224-7914
Practice Address - Street 1:610 FREEDOM BUSINESS CTR DR STE 100
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1329
Practice Address - Country:US
Practice Address - Phone:484-224-7913
Practice Address - Fax:484-224-7914
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist