Provider Demographics
NPI:1548287097
Name:HYLAND, KEVIN J (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:HYLAND
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1662
Mailing Address - Country:US
Mailing Address - Phone:719-533-1318
Mailing Address - Fax:719-533-1319
Practice Address - Street 1:202 E CHEYENNE MOUNTAIN BLVD STE N
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3769
Practice Address - Country:US
Practice Address - Phone:719-527-9331
Practice Address - Fax:719-527-9372
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176545Medicaid
P00001708OtherRAILROAD MEDICARE