Basic Information
| Provider Information | |||||||||
| NPI: | 1295283539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 WOLF RD STE E | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776326637 | ||||||||
| FaxNumber: | 7084095179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 WOLF RD STE E | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776326637 | ||||||||
| FaxNumber: | 7084095179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2016 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-022561 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.