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NPI Code Detail

MEDICARE: MARY ELIZABETH KYLE DPT

MEDICARE: MARY ELIZABETH KYLE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist11118-024WI
2225100000XPhysical Therapist070015014IL

General Provider Information

NPI Number : 1265682538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH KYLE DPT
Provider Business Mailing Address
First Line : 5846 N RIVER BAY RD
Second Line :
City : WATERFORD
State : WI
Zip : 53185-3033
Country : US
Telephone Number : 309-368-5280
Fax Number :
Provider Business Practice Location Address
First Line : 25250 75TH ST
Second Line :
City : SALEM
State : WI
Zip : 53168-8705
Country : US
Telephone Number : 262-843-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2008
Last Update Date : 01/28/2009

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