Provider Demographics
NPI:1093843591
Name:CRAGER, KYLE BRANNON (MPT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:BRANNON
Last Name:CRAGER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 524
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39477
Mailing Address - Country:US
Mailing Address - Phone:601-428-0485
Mailing Address - Fax:
Practice Address - Street 1:23 MASON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4437
Practice Address - Country:US
Practice Address - Phone:607-399-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist