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General NPI Number Information
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NPI Number | 1245296920
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Entity Type | Individual
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Provider Name | KYLE BRYANT HERRIG MS,ATC,CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2065 S COTTONWOOD DR SUITE 1
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City | TEMPE
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State | AZ
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Zip | 85282-3040
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Country | US
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Telephone | 480-968-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 4343 E TORREY PINES LN
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City | CHANDLER
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State | AZ
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Zip | 85249-7157
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Country | US
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Telephone | 480-821-0963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0416
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License Number State | AZ
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