Healthcare Provider Details

I. General information

NPI: 1992430078
Provider Name (Legal Business Name): KYLE ANDROYNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46471 HAYES RD
SHELBY TOWNSHIP MI
48315-5504
US

IV. Provider business mailing address

15889 THUNDER RIDGE CT
CLINTON TOWNSHIP MI
48038-3635
US

V. Phone/Fax

Practice location:
  • Phone: 740-953-1184
  • Fax:
Mailing address:
  • Phone: 586-569-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: