Individual
TYLER KIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
32302 CAMINO CAPISTRANO STE 106, SAN JUAN CAPISTRANO, CA 92675-4505
(949) 276-8845
Mailing address
1235 W TOWN AND COUNTRY RD APT 1204, ORANGE, CA 92868-4613
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
303189
CA
Other
Enumeration date
11/18/2022
Last updated
11/18/2022
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