Provider Demographics
NPI:1447840384
Name:PADASAK, KYLEE RENAE (PT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:RENAE
Last Name:PADASAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 E BRANCH DAM RD
Mailing Address - Street 2:
Mailing Address - City:WILCOX
Mailing Address - State:PA
Mailing Address - Zip Code:15870-5202
Mailing Address - Country:US
Mailing Address - Phone:814-594-3553
Mailing Address - Fax:
Practice Address - Street 1:52 E BRANCH DAM RD
Practice Address - Street 2:
Practice Address - City:WILCOX
Practice Address - State:PA
Practice Address - Zip Code:15870-5202
Practice Address - Country:US
Practice Address - Phone:814-594-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist