Healthcare Provider Details

I. General information

NPI: 1538688734
Provider Name (Legal Business Name): KYLE BELL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-2923
US

IV. Provider business mailing address

9692 PRAIRIE SMOKE DR
NOBLESVILLE IN
46060-4307
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-4211
  • Fax:
Mailing address:
  • Phone: 317-670-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005530A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: