Provider Demographics
NPI:1306183850
Name:STAIRS, KYLE AARON (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:AARON
Last Name:STAIRS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 HAGUE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1754
Mailing Address - Country:US
Mailing Address - Phone:317-964-7730
Mailing Address - Fax:317-964-7708
Practice Address - Street 1:7802 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1754
Practice Address - Country:US
Practice Address - Phone:317-964-7730
Practice Address - Fax:317-964-7708
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001803A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer