Provider Demographics
NPI:1003193210
Name:NEED, KYLE L (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:L
Last Name:NEED
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SASSAFRAS CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2584
Mailing Address - Country:US
Mailing Address - Phone:574-583-2910
Mailing Address - Fax:
Practice Address - Street 1:905 SASSAFRAS CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2584
Practice Address - Country:US
Practice Address - Phone:574-583-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000873A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer