Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 13343 | AZ |
NPI | 1023528387 |
---|---|
Provider Name | Kyle Flood |
First Address | Phoenix, AZ 85048-4103 |
Second Address | Casa Grande, AZ 85122-5757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2017 |
Last Update Date | 01/10/2017 |