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General NPI Number Information
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NPI Number | 1689498891
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Entity Type | Individual
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Provider Name | KYLE MORGAN SHERRY ATC
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 6815 NOBLE AVE
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City | VAN NUYS
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State | CA
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Zip | 91405-3796
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Country | US
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Telephone | 818-901-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 883 VISTA DEL MAR PL APT 302
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City | VENTURA
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State | CA
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Zip | 93001-3759
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Country | US
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Telephone | 805-405-6398
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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 | 2000002601
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License Number State |
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