Provider Demographics
NPI:1295820744
Name:DEVRIEZE, KYLE D (LPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:DEVRIEZE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4478 WEST SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618
Mailing Address - Country:US
Mailing Address - Phone:989-465-9294
Mailing Address - Fax:
Practice Address - Street 1:4478 WEST SAGINAW RD
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618
Practice Address - Country:US
Practice Address - Phone:989-465-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist