Provider Demographics
NPI:1376940791
Name:BOYCE, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BOYCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 RECREATION DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6107
Mailing Address - Country:US
Mailing Address - Phone:636-239-9979
Mailing Address - Fax:
Practice Address - Street 1:324 MCHUGH DR
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-6328
Practice Address - Country:US
Practice Address - Phone:314-852-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070027292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007002729Other2255A2300X