Provider Demographics
NPI:1720832306
Name:CHRIST, KYLE W (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:W
Last Name:CHRIST
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 1:4004 NORTON LN STE 204
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5973
Mailing Address - Country:US
Mailing Address - Phone:850-222-5552
Mailing Address - Fax:
Practice Address - Street 1:4501 W SHANNON LAKES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2221
Practice Address - Country:US
Practice Address - Phone:850-852-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist