Provider Demographics
NPI:1083080352
Name:KYLE, SARINA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8774 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:ARPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54410-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8774 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:ARPIN
Practice Address - State:WI
Practice Address - Zip Code:54410-9715
Practice Address - Country:US
Practice Address - Phone:262-215-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1708 - 392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1708 - 39OtherWISCONSIN LICENSE
2000019268OtherNATA CERTIFICATION