Healthcare Provider Details

I. General information

NPI: 1699820894
Provider Name (Legal Business Name): MARY ELLEN KYLE M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 E MARKET ST SUITE 142
RHINEBECK NY
12572-1727
US

IV. Provider business mailing address

10 RYAN CT
CLINTON CORNERS NY
12514-2039
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-3595
  • Fax: 845-876-0465
Mailing address:
  • Phone: 845-266-3618
  • Fax: 845-876-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011282-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: