Provider Demographics
NPI:1497233472
Name:ROLIARD, KYLE (DPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ROLIARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 N DAISY LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5114
Mailing Address - Country:US
Mailing Address - Phone:713-865-2999
Mailing Address - Fax:
Practice Address - Street 1:907 SE VILLAGE LOOP STE 5
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-2229
Practice Address - Country:US
Practice Address - Phone:479-268-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist