Healthcare Provider Details

I. General information

NPI: 1285993600
Provider Name (Legal Business Name): KYLE A REED DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 W 63RD ST
SHAWNEE KS
66216-3800
US

IV. Provider business mailing address

17134 BEL RAY PL
BELTON MO
64012-5331
US

V. Phone/Fax

Practice location:
  • Phone: 913-962-7770
  • Fax: 913-962-7775
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04418
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: