Healthcare Provider Details

I. General information

NPI: 1417241480
Provider Name (Legal Business Name): KYLE TIMOTHY NETTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 E COUNTY LINE RD SUITE E
GREENWOOD IN
46143-1067
US

IV. Provider business mailing address

1641 NORTH 800 W ROAD
BARGERSVILLE IN
46106
US

V. Phone/Fax

Practice location:
  • Phone: 317-883-4374
  • Fax: 317-883-4384
Mailing address:
  • Phone: 317-422-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: