Healthcare Provider Details

I. General information

NPI: 1477281954
Provider Name (Legal Business Name): KYLE METHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E 4TH ST
CHATTANOOGA TN
37403-1925
US

IV. Provider business mailing address

1175 PINEVILLE RD APT 85
CHATTANOOGA TN
37405-2650
US

V. Phone/Fax

Practice location:
  • Phone: 423-425-4706
  • Fax:
Mailing address:
  • Phone: 951-310-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number204C00000X
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number207PS0010X
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number2083S0010X
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number2084S0010X
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2081S0010X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: