Provider Demographics
NPI:1386679454
Name:DANEMAYER, KYLE ALBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ALBERT
Last Name:DANEMAYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-733-9333
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:6909 GOOD SAMARITAN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5207
Practice Address - Country:US
Practice Address - Phone:513-245-5434
Practice Address - Fax:513-245-5424
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.009000225100000X
KY004065225100000X
IN05008966A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000490648OtherANTHEM
OHP00352633OtherMEDICARE RAILROAD
OH2712176Medicaid
OH0225920002Medicare NSC
OH2712176Medicaid