Provider Demographics
NPI:1962094763
Name:HOGWOOD, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HOGWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WILLOW LAWN DR STE 230
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3003
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:
Practice Address - Street 1:1700 WILLOW LAWN DR STE 230
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3003
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist