MEDICARE: KYLE SPAIN LMT

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	225700000X	Massage Therapist	0019013421	VA

General Provider Information

NPI Number	:	1669266771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SPAIN LMT

Provider Business Mailing Address
First Line	:	3201 LANDOVER ST APT 623
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-1916
Country	:	US
Telephone Number	:	703-420-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 N GARFIELD ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2164
Country	:	US
Telephone Number	:	571-483-3333
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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Directions to “ KYLE SPAIN LMT” Practice Location

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