Provider Demographics
NPI:1659770162
Name:BAER, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BAER
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 1:241 GRIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2958
Mailing Address - Country:US
Mailing Address - Phone:814-602-6819
Mailing Address - Fax:
Practice Address - Street 1:241 GRIDLEY AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2958
Practice Address - Country:US
Practice Address - Phone:814-602-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer