Provider Demographics
NPI:1285662882
Name:EADS, KYLE WAYNE (LPT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:WAYNE
Last Name:EADS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 GINNY LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5594
Mailing Address - Country:US
Mailing Address - Phone:336-475-9676
Mailing Address - Fax:336-765-1396
Practice Address - Street 1:2828 MAPLEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4138
Practice Address - Country:US
Practice Address - Phone:336-765-4703
Practice Address - Fax:336-765-1396
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist