Provider Demographics
NPI:1437505039
Name:POWELL, KYLIE (ATC)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1428
Mailing Address - Country:US
Mailing Address - Phone:215-264-8993
Mailing Address - Fax:
Practice Address - Street 1:1 NORTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9472
Practice Address - Country:US
Practice Address - Phone:215-264-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer