Provider Demographics
NPI:1114168119
Name:CROW, KYLE L
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:L
Last Name:CROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BRIARVILLE RD BLDG D
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5136
Mailing Address - Country:US
Mailing Address - Phone:615-612-7602
Mailing Address - Fax:
Practice Address - Street 1:1210 BRIARVILLE RD BLDG D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5136
Practice Address - Country:US
Practice Address - Phone:615-612-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist