Provider Demographics
NPI:1235729864
Name:PERRY, KYLE GREGORY (LMT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:GREGORY
Last Name:PERRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842B S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-3408
Mailing Address - Country:US
Mailing Address - Phone:615-720-8029
Mailing Address - Fax:
Practice Address - Street 1:3842B S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOBELVILLE
Practice Address - State:TN
Practice Address - Zip Code:37097-3408
Practice Address - Country:US
Practice Address - Phone:615-720-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist