Kyle G Roberts, C. PED.
Individual provider Active NPI Orthotic Fitter · Wales, WI
NPI 1508032384 · NPPES record last updated May 2, 2008
Key facts
- NPI
- 1508032384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthotic Fitter 225000000X
- Practice address
- W314S2556 Penny LN
Wales, WI 53183-9671 - Phone
- (262) 968-3643
- NPI assigned
- May 1, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Footworks Orthotics, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | Yes |
Addresses
Primary practice location
W314S2556 Penny LN
Wales, WI 53183-9671
Mailing address
W314S2556 Penny LN
Wales, WI 53183-9671
Phone (262) 968-3643
Other providers in Wales, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.