Provider Demographics
NPI:1699820894
Name:KYLE, MARY ELLEN (MSPT)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RYAN CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2039
Mailing Address - Country:US
Mailing Address - Phone:845-266-3618
Mailing Address - Fax:845-876-0465
Practice Address - Street 1:187 E MARKET ST
Practice Address - Street 2:SUITE 142
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1727
Practice Address - Country:US
Practice Address - Phone:845-876-3595
Practice Address - Fax:845-876-0465
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011282-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10034485OtherCDPHP PROVIDER NUMBER
NY437026OtherMVP PROVIDER NUMBER