Healthcare Provider Details

I. General information

NPI: 1124980545
Provider Name (Legal Business Name): KYLE CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 STRATFORD AVE
EWING NJ
08618-1978
US

IV. Provider business mailing address

27 STRATFORD AVE
EWING NJ
08618-1978
US

V. Phone/Fax

Practice location:
  • Phone: 609-510-3232
  • Fax:
Mailing address:
  • Phone: 609-510-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00054500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: