Provider Demographics
NPI:1366526915
Name:CLONTZ, KYLE ALDEN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ALDEN
Last Name:CLONTZ
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 1:4756 SAWMILLS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-9466
Mailing Address - Country:US
Mailing Address - Phone:828-396-1824
Mailing Address - Fax:828-728-5996
Practice Address - Street 1:4132 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-8371
Practice Address - Country:US
Practice Address - Phone:828-396-3168
Practice Address - Fax:828-728-8317
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist