Provider Demographics
NPI:1417241480
Name:NETTER, KYLE TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:TIMOTHY
Last Name:NETTER
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 1:1641 NORTH 800 W ROAD
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106
Mailing Address - Country:US
Mailing Address - Phone:317-422-4975
Mailing Address - Fax:
Practice Address - Street 1:549 E COUNTY LINE RD
Practice Address - Street 2:SUITE E
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1067
Practice Address - Country:US
Practice Address - Phone:317-883-4374
Practice Address - Fax:317-883-4384
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006752A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist