MEDICARE: KYLE KATHLEEN PRIDE PTA

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	225200000X	Physical Therapy Assistant	J2-0000548	DE

General Provider Information

NPI Number	:	1770540874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE KATHLEEN PRIDE PTA

Provider Business Mailing Address
First Line	:	721 REHOBOTH AVE
Second Line	:	SUITE 12
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-3169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 REHOBOTH AVE
Second Line	:	SUITE 12
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-3169
Country	:	US
Telephone Number	:	302-227-2008
Fax Number	:	302-227-8098

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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Directions to “ KYLE KATHLEEN PRIDE PTA” Practice Location

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