MEDICARE: KYLE GREVE

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1386327039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE GREVE

Provider Business Mailing Address
First Line	:	1479 ROUTE 23 STE 201
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7507
Country	:	US
Telephone Number	:	973-686-0007
Fax Number	:	973-686-0001

Provider Business Practice Location Address
First Line	:	1479 ROUTE 23 STE 201
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7507
Country	:	US
Telephone Number	:	973-686-0007
Fax Number	:	973-686-0001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	03/20/2026

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Directions to “ KYLE GREVE ” Practice Location

Language	Start Address	Practice Location

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