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NPI Code Detail

MEDICARE: MR. KYLE D HAILEY AAS

MEDICARE: MR. KYLE D HAILEY AAS
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1780876664
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KYLE D HAILEY AAS
Provider Business Mailing Address
First Line : PO BOX 1019
Second Line :
City : LUVERNE
State : MN
Zip : 56156-2519
Country : US
Telephone Number : 507-449-1229
Fax Number :
Provider Business Practice Location Address
First Line : 1600 N. KNISS AVE.
Second Line :
City : LUVERNE
State : MN
Zip : 56156-1067
Country : US
Telephone Number : 507-449-1229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 08/14/2007

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Directions to “ MR. KYLE D HAILEY AAS” Practice Location

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