Provider Demographics
NPI:1497012884
Name:MCINTYRE, KYLE DAVID (DPT, FFMT, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DAVID
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:DPT, FFMT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 VAUGHAN ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3732
Mailing Address - Country:US
Mailing Address - Phone:603-403-5040
Mailing Address - Fax:
Practice Address - Street 1:233 VAUGHAN ST STE 102A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3732
Practice Address - Country:US
Practice Address - Phone:603-403-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23999225100000X
NH47822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist