Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT026362 | PA |
NPI | 1003318817 |
---|---|
Provider Name | Kyle Stephen Kasman |
First Address | Bethlehem, PA 18020-8062 |
Second Address | Bethlehem, PA 18020-8062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |