Provider Demographics
NPI:1619932647
Name:WEBSTER, KYLE W (ATC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:W
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310B S KEENELAND DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3228
Mailing Address - Country:US
Mailing Address - Phone:859-625-9181
Mailing Address - Fax:
Practice Address - Street 1:ADVANCED ORTHOPAEDICS & SPORTS MEDICINE
Practice Address - Street 2:789 EASTERN BYPASS, SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3228
Practice Address - Country:US
Practice Address - Phone:859-624-4110
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer