Provider Demographics
NPI:1588012793
Name:KREUL, KYLE AARON
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:AARON
Last Name:KREUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 MEHTA LN
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9178
Mailing Address - Country:US
Mailing Address - Phone:920-568-9739
Mailing Address - Fax:920-568-9742
Practice Address - Street 1:1618 MEHTA LN
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-9178
Practice Address - Country:US
Practice Address - Phone:920-568-9739
Practice Address - Fax:920-568-9742
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1337224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist