Provider Demographics
NPI:1326066325
Name:SCHANEVILLE, KYLE MICHAEL (PT, DPT, OCS, MTC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MICHAEL
Last Name:SCHANEVILLE
Suffix:
Gender:M
Credentials:PT, DPT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 VISTA CAY CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7350
Mailing Address - Country:US
Mailing Address - Phone:813-952-4463
Mailing Address - Fax:
Practice Address - Street 1:721 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4934
Practice Address - Country:US
Practice Address - Phone:813-654-1410
Practice Address - Fax:813-657-9544
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist