Active NPI
Kylee Liddle
- Rehabilitation Practitioner
- Vallejo, CA
National Provider Identifier
1184322554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 160 Glen Cove Marina Rd E
Vallejo, CA 94591-7290 - Phone
- (707) 648-2000
- NPI assigned
- Feb 15, 2023
- Last updated
- Apr 24, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | CA | Primary | |
| Behavior Technician | 106S00000X | NU |
Addresses
Primary practice location
160 Glen Cove Marina Rd E
Vallejo, CA 94591-7290
Mailing address
160 Glen Cove Marina Rd E
Vallejo, CA 94591-7290
Other names 1
- Kyle Liddle
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776988800000",
"number": "1184322554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 GLEN COVE MARINA RD E",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945917290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 GLEN COVE MARINA RD E",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945917290",
"telephone_number": "707-648-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDLE",
"first_name": "KYLEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-15",
"last_updated": "2026-04-24",
"certification_date": "2026-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KYLE",
"last_name": "LIDDLE",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.