Provider Demographics
NPI:1407530017
Name:MCINTYRE, KYLE S
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:S
Last Name:MCINTYRE
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 1:230 N MAPLE AVE STE B10
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9423
Mailing Address - Country:US
Mailing Address - Phone:856-396-2500
Mailing Address - Fax:856-396-2525
Practice Address - Street 1:230 N MAPLE AVE STE B10
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9423
Practice Address - Country:US
Practice Address - Phone:856-396-2500
Practice Address - Fax:856-396-2525
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02179900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist