Provider Demographics
NPI:1558658831
Name:MEYER, KYLE ALWAYNE (PT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALWAYNE
Last Name:MEYER
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 1:11107 BLACK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1525
Mailing Address - Country:US
Mailing Address - Phone:712-490-5738
Mailing Address - Fax:
Practice Address - Street 1:18101 R PLZ
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1928
Practice Address - Country:US
Practice Address - Phone:402-933-8333
Practice Address - Fax:402-933-4755
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist