Active NPI
Kyle Wade, DPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1710780796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 307574
- Practice address
- 12264 El Camino Real Ste 60
San Diego, CA 92130-3059 - Phone
- (619) 955-9250
- NPI assigned
- Mar 27, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 307574 | CA | Primary |
Addresses
Primary practice location
12264 El Camino Real Ste 60
San Diego, CA 92130-3059
Mailing address
1111 6TH Ave
Ste 550 #331346
San Diego, CA 92101
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 307574 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1710780796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 6TH AVE",
"address_2": "STE 550 #331346",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12264 EL CAMINO REAL STE 60",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921303059",
"telephone_number": "619-955-9250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "KYLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-27",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "307574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.