Individual
KYLE FARDANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9105 FOUR SEASONS DR, ELK GROVE, CA 95624-1288
(916) 792-1889
Mailing address
9105 FOUR SEASONS DR, ELK GROVE, CA 95624-1288
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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