MEDICARE: KYLE M. COX P.T.A.

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	3565	TN

General Provider Information

NPI Number	:	1932249703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE M. COX P.T.A.

Provider Business Mailing Address
First Line	:	9147 LAKEVIEW DR
Second Line	:
City	:	SOUTH FULTON
State	:	TN
Zip	:	38257-7605
Country	:	US
Telephone Number	:	731-479-8665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 E REELFOOT AVE STE 2
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-6050
Country	:	US
Telephone Number	:	731-885-1077
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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