Provider Demographics
NPI:1609512755
Name:CONTRERAS, KYLE (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 REVOLUTION DR
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2565
Mailing Address - Country:US
Mailing Address - Phone:914-907-7066
Mailing Address - Fax:
Practice Address - Street 1:325 AYER RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1132
Practice Address - Country:US
Practice Address - Phone:978-396-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist