Provider Demographics
NPI:1073770160
Name:SLAVIK, KYLIE BETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:BETH
Last Name:SLAVIK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3309
Mailing Address - Country:US
Mailing Address - Phone:352-339-0617
Mailing Address - Fax:
Practice Address - Street 1:1717 NW 51ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3309
Practice Address - Country:US
Practice Address - Phone:352-339-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 52830172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist