Healthcare Provider Details

I. General information

NPI: 1235729864
Provider Name (Legal Business Name): KYLE GREGORY PERRY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S MAIN ST
LOBELVILLE TN
37097-3276
US

IV. Provider business mailing address

32 DUNCAN CIR
LOBELVILLE TN
37097-3428
US

V. Phone/Fax

Practice location:
  • Phone: 615-720-8029
  • Fax:
Mailing address:
  • Phone: 615-720-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12802
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: