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General NPI Number Information
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NPI Number | 1508484189
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Entity Type | Individual
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Provider Name | KYLE DALTON FLORA LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 577 5TH AVE RM 1103
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City | YOUNGSTOWN
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State | OH
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Zip | 44502
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Country | US
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Telephone | 330-941-3190
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Fax |
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Provider Business Mailing Address
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Address Line | 4841 WESTCHESTER DR APT 320
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2555
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Country | US
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Telephone | 206-794-3778
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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 | AT006177
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License Number State | OH
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