1073064572 NPI number — ASHLEY ELIZABETH KYGER HENRY PT, DPT, CSCS

Table of content: ASHLEY ELIZABETH KYGER HENRY PT, DPT, CSCS (NPI 1073064572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073064572 NPI number — ASHLEY ELIZABETH KYGER HENRY PT, DPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KYGER HENRY
Provider First Name:
ASHLEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CSCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KYGER
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073064572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1665 BELLEVILLE WAY
Provider Second Line Business Mailing Address:
APT K
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94087-3959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-358-5274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20823 STEVENS CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-252-6076
Provider Business Practice Location Address Fax Number:
408-252-1159
Provider Enumeration Date:
10/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT292088 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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