Provider Demographics
NPI:1104201508
Name:BARLOW, KYLE (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BARLOW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FLYCATCHER DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7341
Mailing Address - Country:US
Mailing Address - Phone:740-370-8558
Mailing Address - Fax:
Practice Address - Street 1:1293 OLD HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:CROSS
Practice Address - State:SC
Practice Address - Zip Code:29436-3578
Practice Address - Country:US
Practice Address - Phone:843-899-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20000216162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer