Provider Demographics
NPI:1306384441
Name:MOREY, KYLE RICHARD (AT, PT, DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:RICHARD
Last Name:MOREY
Suffix:
Gender:M
Credentials:AT, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WISTERIA DR STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:1839 BUFORD HWY STE 100
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3672
Practice Address - Country:US
Practice Address - Phone:678-450-9933
Practice Address - Fax:678-450-9966
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20942255A2300X
GAPT013962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer