Provider Demographics
NPI:1154631752
Name:STARR, KYLIE MILLER (DPT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MILLER
Last Name:STARR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MAYBROOK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2743
Mailing Address - Country:US
Mailing Address - Phone:845-636-4344
Mailing Address - Fax:845-636-4355
Practice Address - Street 1:505 STATE ROUTE 208
Practice Address - Street 2:SUITE 30
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1608
Practice Address - Country:US
Practice Address - Phone:845-782-3200
Practice Address - Fax:845-782-3100
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04179225100000X
NY038241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist