MEDICARE: KYLE HAINES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	13396878-2401	UT

General Provider Information

NPI Number	:	1568141885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE HAINES PT

Provider Business Mailing Address
First Line	:	258 S MAIN ST STE 210
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84321-5768
Country	:	US
Telephone Number	:	435-383-6120
Fax Number	:	435-557-8003

Provider Business Practice Location Address
First Line	:	990 MEDICAL DR STE U4
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-4714
Country	:	US
Telephone Number	:	435-723-6487
Fax Number	:	435-723-6490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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Directions to “ KYLE HAINES PT” Practice Location

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