Provider Demographics
NPI:1457507139
Name:BAIRD, KYLE EVERETT (MPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:EVERETT
Last Name:BAIRD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18145 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-4275
Mailing Address - Country:US
Mailing Address - Phone:707-933-8592
Mailing Address - Fax:
Practice Address - Street 1:18145 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-4275
Practice Address - Country:US
Practice Address - Phone:707-933-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist